MEDICARE: AYAM DE LEON PT, P.C.

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	261QP2000X	Physical Therapy Clinic/Center	022973	NY

General Provider Information

NPI Number	:	1659517662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AYAM DE LEON PT, P.C.

Provider Business Mailing Address
First Line	:	637 CARDINAL RD
Second Line	:
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-5201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8798 193RD ST
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-1439
Country	:	US
Telephone Number	:	845-282-1022
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. AYAM TIRONA DE LEON
Credential	:
Telephone Number	:	845-282-1022

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	10/16/2015

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