Provider Demographics
NPI:1760634083
Name:AIELLO, STEPHEN (MSPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:AIELLO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:
Other - Last Name:AIELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19 COLBY FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2645
Mailing Address - Country:US
Mailing Address - Phone:908-879-8279
Mailing Address - Fax:
Practice Address - Street 1:10 W HANOVER AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4221
Practice Address - Country:US
Practice Address - Phone:973-895-4300
Practice Address - Fax:973-895-4302
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00904300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist