Healthcare Provider Details

I. General information

NPI: 1649260001
Provider Name (Legal Business Name): ARAN DEGENHARDT MD, MPH&TM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W 24TH ST FL 2
NEW YORK NY
10010-3560
US

IV. Provider business mailing address

30 W 24TH ST FL 2
NEW YORK NY
10010-3560
US

V. Phone/Fax

Practice location:
  • Phone: 212-366-5100
  • Fax: 212-366-6275
Mailing address:
  • Phone: 212-366-5100
  • Fax: 212-366-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number234008
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number234008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: