Provider Demographics
NPI:1285613083
Name:NIELSEN, KIMBERLY D (PT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:D
Last Name:NIELSEN
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 1:140 METEDECONK RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5442
Mailing Address - Country:US
Mailing Address - Phone:732-604-0626
Mailing Address - Fax:732-929-7407
Practice Address - Street 1:140 METEDECONK RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-5442
Practice Address - Country:US
Practice Address - Phone:732-604-0626
Practice Address - Fax:732-929-7407
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020669-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2354169OtherUNITED HEALTH CARE
NY175564OtherELDERPLAN
NY020669OtherHIP
NM6697876OtherGHI
NY281691AOtherMAGNA HEALTHCARE
NY839874OtherMANAGED PLAN NETWORK
NY2354169OtherUNITED HEALTH CARE