Healthcare Provider Details

I. General information

NPI: 1245754944
Provider Name (Legal Business Name): ESTHER Y KIM PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CARLTON LN
HARRINGTON PARK NJ
07640-1603
US

IV. Provider business mailing address

90 CARLTON LN
HARRINGTON PARK NJ
07640-1603
US

V. Phone/Fax

Practice location:
  • Phone: 201-230-1334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01757800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT026365
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number045823
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: