Provider Demographics
NPI:1285265827
Name:ARANDELA, MARK C (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:ARANDELA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2817
Mailing Address - Country:US
Mailing Address - Phone:862-571-5511
Mailing Address - Fax:
Practice Address - Street 1:103 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1827
Practice Address - Country:US
Practice Address - Phone:201-688-3336
Practice Address - Fax:646-933-4271
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01694200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist