Healthcare Provider Details

I. General information

NPI: 1952146029
Provider Name (Legal Business Name): AVENIR VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN ST STE 253
HACKENSACK NJ
07601-7086
US

IV. Provider business mailing address

3854 AMERICAN WAY STE A
BATON ROUGE LA
70816-4897
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-7766
  • Fax:
Mailing address:
  • Phone: 225-292-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TRAVIS MIGLICCO
Title or Position: SVP TAX
Credential:
Phone: 225-299-3803