MEDICARE: AYAM TIRONA DELEON PT

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	2251P0200X	Pediatric Physical Therapist	0229731	NY
2	2251X0800X	Orthopedic Physical Therapist	0229731	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11934054	OTHER		CAQH

General Provider Information

NPI Number	:	1821084385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYAM TIRONA DELEON PT

Provider Business Mailing Address
First Line	:	637 CARDINAL RD
Second Line	:
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-5201
Country	:	US
Telephone Number	:	845-282-1022
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	:	718-291-4703
Fax Number	:	914-739-3140

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	02/08/2012

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Directions to “ AYAM TIRONA DELEON PT” Practice Location

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