Provider Demographics
NPI:1619079183
Name:AARONSON, AARON (RPH)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:AARONSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:AARON
Other - Middle Name:
Other - Last Name:USTAYEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:17636 KILDARE RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1413
Mailing Address - Country:US
Mailing Address - Phone:917-576-0497
Mailing Address - Fax:
Practice Address - Street 1:1348 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4120
Practice Address - Country:US
Practice Address - Phone:718-513-6644
Practice Address - Fax:718-513-6449
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1619079183Medicaid