Healthcare Provider Details

I. General information

NPI: 1235694506
Provider Name (Legal Business Name): PRESTIGE INFUSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BOONTON AVE
KINNELON NJ
07405-2910
US

IV. Provider business mailing address

6601 LYONS RD STE L6
COCONUT CREEK FL
33073-3639
US

V. Phone/Fax

Practice location:
  • Phone: 914-906-4004
  • Fax: 973-909-4540
Mailing address:
  • Phone: 561-212-3816
  • Fax: 973-909-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: AYSHA AHMED
Title or Position: ADMIN
Credential:
Phone: 973-653-8844