Provider Demographics
NPI:1649260001
Name:DEGENHARDT, ARAN (MD, MPH&TM)
Entity type:Individual
Prefix:DR
First Name:ARAN
Middle Name:
Last Name:DEGENHARDT
Suffix:
Gender:M
Credentials:MD, MPH&TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 24TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3560
Mailing Address - Country:US
Mailing Address - Phone:212-366-5100
Mailing Address - Fax:212-366-6275
Practice Address - Street 1:30 W 24TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3560
Practice Address - Country:US
Practice Address - Phone:212-366-5100
Practice Address - Fax:212-366-6275
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234008207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI42829Medicare UPIN