Provider Demographics
NPI:1417308917
Name:BUMPUS, AARON (LMT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:BUMPUS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 WOODHAVEN BLVD
Mailing Address - Street 2:#2C
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2769
Mailing Address - Country:US
Mailing Address - Phone:718-775-5249
Mailing Address - Fax:
Practice Address - Street 1:34 W 22ND ST
Practice Address - Street 2:2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5805
Practice Address - Country:US
Practice Address - Phone:212-255-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist