Provider Demographics
NPI:1750338588
Name:KIMIATEK, DEENA A (PT)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:A
Last Name:KIMIATEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 MILLBURN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1845
Mailing Address - Country:US
Mailing Address - Phone:212-226-2066
Mailing Address - Fax:212-500-0039
Practice Address - Street 1:2403 HARNISH DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-6803
Practice Address - Country:US
Practice Address - Phone:847-854-6482
Practice Address - Fax:847-854-6483
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040110-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP NUMBER
IL1623066OtherBCBS IL PROVIDER #
IL202542OtherMEDICARE GROUP #
IL567700OtherMEDICARE GROUP NUMBER
IL200852OtherMEDICARE GROUP #
IL568080OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
IL367885100OtherU.S. DEPT. OF LABOR
IL567700OtherMEDICARE GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
ILK51719Medicare PIN
ILK 23944Medicare UPIN