Provider Demographics
NPI:1619084100
Name:ANGUD, AIMEE (PT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:ANGUD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7639
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:87 SUMMIT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1262
Practice Address - Country:US
Practice Address - Phone:201-488-7905
Practice Address - Fax:201-488-7901
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01064200OtherLICENSE #