Healthcare Provider Details

I. General information

NPI: 1407216849
Provider Name (Legal Business Name): SHARON CIMBOL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2016
Last Update Date: 02/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 SYCAMORE TER
LIVINGSTON NJ
07039-4618
US

IV. Provider business mailing address

16 SYCAMORE TER
LIVINGSTON NJ
07039-4618
US

V. Phone/Fax

Practice location:
  • Phone: 201-618-5016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00732700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: