Healthcare Provider Details

I. General information

NPI: 1497885529
Provider Name (Legal Business Name): AARON GEWANT P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W MAIN ST
CHESTER NJ
07930-2487
US

IV. Provider business mailing address

4175 VETERANS MEMORIAL HWY
RONKONKOMA NY
11779-7639
US

V. Phone/Fax

Practice location:
  • Phone: 908-879-7364
  • Fax: 908-879-7365
Mailing address:
  • Phone: 631-580-5200
  • Fax: 631-580-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01126300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: