Basic Information
| Provider Information | |||||||||
| NPI: | 1235374083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARANJO | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1377 MOTOR PKWY | ||||||||
| Address2: | STE 307 | ||||||||
| City: | ISLANDIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117495258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105805200 | ||||||||
| FaxNumber: | 6317608306 | ||||||||
| Practice Location | |||||||||
| Address1: | 2966 STREET RD | ||||||||
| Address2: | |||||||||
| City: | BENSALEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190202604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156392639 | ||||||||
| FaxNumber: | 2159292464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2008 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT019595 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3745110000 | 01 | PA | IBC | OTHER | 2122909 | 01 | PA | HIGHMARK PABS | OTHER | 30068692 | 01 | KEYSTONE MERCY | OTHER | 102404700-0001 | 05 | PA | MEDICAID | 306060 | 01 | UNISON | OTHER |