Provider Demographics
NPI:1437271848
Name:BAQUIRAN, KIMBERLYN JANE (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLYN
Middle Name:JANE
Last Name:BAQUIRAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLYN JANE
Other - Middle Name:CARLOS
Other - Last Name:BAQUIRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:52 COUNTRY VILLAGE RD
Mailing Address - Street 2:#1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1204
Mailing Address - Country:US
Mailing Address - Phone:551-998-5933
Mailing Address - Fax:201-369-1239
Practice Address - Street 1:52 COUNTRY VILLAGE RD
Practice Address - Street 2:#1
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1204
Practice Address - Country:US
Practice Address - Phone:551-998-5933
Practice Address - Fax:201-369-1239
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024312-1225100000X
NJ40QA01109600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist