MEDICARE: IRAIDA ARVELO LMT

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	225700000X	Massage Therapist	18KT00761500	NJ
2	252Y00000X	Early Intervention Provider Agency
3	103K00000X	Behavior Analyst	18KT00761500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2012591236	OTHER		SELF

General Provider Information

NPI Number	:	1831756071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRAIDA ARVELO LMT

Provider Business Mailing Address
First Line	:	164 MOUNT PLEASANT AVE
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-2732
Country	:	US
Telephone Number	:	201-259-1236
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 MOUNT PLEASANT AVE
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-2732
Country	:	US
Telephone Number	:	201-259-1236
Fax Number	:

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

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	05/23/2019

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