MEDICARE: MR. AARON GEWANT P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01126300	NJ

General Provider Information

NPI Number	:	1497885529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AARON GEWANT P.T.

Provider Business Mailing Address
First Line	:	4175 VETERANS MEMORIAL HWY
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-7639
Country	:	US
Telephone Number	:	631-580-5200
Fax Number	:	631-580-5222

Provider Business Practice Location Address
First Line	:	95 W MAIN ST
Second Line	:
City	:	CHESTER
State	:	NJ
Zip	:	07930-2487
Country	:	US
Telephone Number	:	908-879-7364
Fax Number	:	908-879-7365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	10/11/2016

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