Provider Demographics
NPI:1821084385
Name:DELEON, AYAM TIRONA (PT)
Entity Type:Individual
Prefix:
First Name:AYAM
Middle Name:TIRONA
Last Name:DELEON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-5201
Mailing Address - Country:US
Mailing Address - Phone:845-282-1022
Mailing Address - Fax:
Practice Address - Street 1:8798 193RD ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1439
Practice Address - Country:US
Practice Address - Phone:718-291-4703
Practice Address - Fax:914-739-3140
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02297312251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
11934054OtherCAQH