Basic Information
Provider Information
NPI: 1003296773
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VAIDYA
FirstName: AADITYA
MiddleName:  
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Mailing Information
Address1: 11575 PEARLAND PKWY APT 3301
Address2:  
City: HOUSTON
State: TX
PostalCode: 770892647
CountryCode: US
TelephoneNumber: 4084443080
FaxNumber:  
Practice Location
Address1: 10509 JAMAICA AVE
Address2:  
City: RICHMOND HILL
State: NY
PostalCode: 114182014
CountryCode: US
TelephoneNumber: 7184413211
FaxNumber: 7184413744
Other Information
ProviderEnumerationDate: 06/08/2015
LastUpdateDate: 12/08/2019
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode: M
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IsSoleProprietor: N
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AuthorizedOfficialCredential:  
NPICertificationDate: 12/08/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X1296743TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X038803-1NYN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
038803-101NYLICENSE NUMBEROTHER
129674301TXLICENSE NUMBEROTHER


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