Provider Demographics
NPI:1003296773
Name:VAIDYA, AADITYA
Entity Type:Individual
Prefix:
First Name:AADITYA
Middle Name:
Last Name:VAIDYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11575 PEARLAND PKWY APT 3301
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2647
Mailing Address - Country:US
Mailing Address - Phone:408-444-3080
Mailing Address - Fax:
Practice Address - Street 1:10509 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2014
Practice Address - Country:US
Practice Address - Phone:718-441-3211
Practice Address - Fax:718-441-3744
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038803-1225100000X
TX1296743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038803-1OtherLICENSE NUMBER
TX1296743OtherLICENSE NUMBER