Provider Demographics
NPI:1205055852
Name:STEWART, AARON JOSEPH (PA STUDENT)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:JOSEPH
Last Name:STEWART
Suffix:
Gender:M
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SWARTSON CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1201
Mailing Address - Country:US
Mailing Address - Phone:518-330-5368
Mailing Address - Fax:
Practice Address - Street 1:121 EVERETT RD STE 200
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1447
Practice Address - Country:US
Practice Address - Phone:518-489-2524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013910-1225XH1200X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6431160001Medicare NSC