Healthcare Provider Details
I. General information
NPI: 1972022747
Provider Name (Legal Business Name): AINSWORTH HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/13/2017
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1103 STEWART AVENUE SUITE 301
GARDEN CITY NY
11530
US
IV. Provider business mailing address
1103 STEWART AVENUE SUITE 301
GARDEN CITY NY
11530
US
V. Phone/Fax
- Phone: 516-243-7775
- Fax: 516-874-5766
- Phone: 516-243-7775
- Fax: 516-874-5766
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QA1903X |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QP3300X |
| Taxonomy | Pain Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
EDWARD
RUBIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 516-359-7246