Provider Demographics
NPI:1821161126
Name:HUPPERT, AARON SIMON (PT)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:SIMON
Last Name:HUPPERT
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 1:1395 LEXINGTON AVE
Mailing Address - Street 2:MEZZANINE LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1612
Mailing Address - Country:US
Mailing Address - Phone:646-707-0400
Mailing Address - Fax:
Practice Address - Street 1:1395 LEXINGTON AVE
Practice Address - Street 2:MEZZANINE LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1612
Practice Address - Country:US
Practice Address - Phone:646-707-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020331-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP3191Medicare ID - Type Unspecified