MEDICARE: AARON FUNTANILLA

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	101YM0800X	Mental Health Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ14842300	NJ

General Provider Information

NPI Number	:	1912644816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON FUNTANILLA

Provider Business Mailing Address
First Line	:	2051 SPRINGDALE RD
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-1603
Country	:	US
Telephone Number	:	856-254-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 CLEMSON RD
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1212
Country	:	US
Telephone Number	:	856-259-1333
Fax Number	:	856-545-1918

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

Provider Enumeration Date	:	05/13/2022
Last Update Date	:	02/07/2026

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Directions to “ AARON FUNTANILLA ” Practice Location

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