Healthcare Provider Details

I. General information

NPI: 1821851197
Provider Name (Legal Business Name): JOEL KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 BROAD ST
BLOOMFIELD NJ
07003-2885
US

IV. Provider business mailing address

235 GRANTWOOD BLVD
PALISADES PARK NJ
07650-1925
US

V. Phone/Fax

Practice location:
  • Phone: 973-404-7067
  • Fax:
Mailing address:
  • Phone: 201-739-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02229700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: