Healthcare Provider Details

I. General information

NPI: 1528730876
Provider Name (Legal Business Name): AXIVA INFUSION CENTERS - PN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ROUTE 31 N STE 103
PENNINGTON NJ
08534-1606
US

IV. Provider business mailing address

3420 FAIRLANE FARMS RD STE 200
WELLINGTON FL
33414-8701
US

V. Phone/Fax

Practice location:
  • Phone: 844-442-9482
  • Fax: 844-440-0101
Mailing address:
  • Phone: 561-955-0920
  • Fax: 844-440-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. COLLEEN S SHAPIRO
Title or Position: MANAGING MEMBER
Credential:
Phone: 561-955-0920