Healthcare Provider Details

I. General information

NPI: 1952739534
Provider Name (Legal Business Name): AYLIN MAHMUT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 VALLEY BLVD
WOOD RIDGE NJ
07075-1201
US

IV. Provider business mailing address

253 VALLEY BLVD
WOOD RIDGE NJ
07075-1201
US

V. Phone/Fax

Practice location:
  • Phone: 732-665-6334
  • Fax: 732-637-8933
Mailing address:
  • Phone: 732-665-6334
  • Fax: 732-637-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number036519
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01539300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: