Provider Demographics
NPI:1992500748
Name:FAVARA, KIMBERLY N (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:N
Last Name:FAVARA
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 JEFFERSON ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-1919
Mailing Address - Country:US
Mailing Address - Phone:908-415-8899
Mailing Address - Fax:
Practice Address - Street 1:18-01 POLLITT DR STE 1A
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2815
Practice Address - Country:US
Practice Address - Phone:201-478-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01266000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist