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Contact Information

AGEWELL DIAGNOSTICS, INC.
1999 MARCUS AVENUE
SUITE M15
LAKE SUCCESS, NY11042
 Phone: 516-488-8808
 Fax: 516-488-8808
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for AGEWELL DIAGNOSTICS, INC.

NPI # 1366930836
LBN Legal business name AGEWELL DIAGNOSTICS, INC.
Authorized official MARK HERBRICH - (OWNER/PT)
Entity Organization
Organization subpart 1 No
Enumeration date 04/30/2018
Last updated 04/30/2018 - About 8 years ago
Identifiers
NY License # 015532-1
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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