=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124898598
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA AIELLO LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2024
-----------------------------------------------------
Last Update Date | 01/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 W 82ND ST STE 108
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10024-5511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-558-0228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 370 MANHATTAN AVE APT 2C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10026-2337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-826-7642
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 027899-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------