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General NPI Number Information
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NPI Number | 1659517662
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Entity Type | Organization
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Legal Business Name | AYAM DE LEON PT, P.C.
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Dates
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Enumeration Date | 12/22/2008
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 8798 193RD ST
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City | HOLLIS
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State | NY
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Zip | 11423-1439
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Country | US
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Telephone | 845-282-1022
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Fax |
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Provider Business Mailing Address
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Address Line | 637 CARDINAL RD
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City | CORTLANDT MANOR
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State | NY
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Zip | 10567-5201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. AYAM TIRONA DE LEON
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Credential |
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Telephone | 845-282-1022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 022973
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License Number State | NY
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