Healthcare Provider Details

I. General information

NPI: 1255046017
Provider Name (Legal Business Name): REPLENISH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NEW YORK AVE FL 2
HUNTINGTON NY
11743-4264
US

IV. Provider business mailing address

700 NEW YORK AVE FL 2
HUNTINGTON NY
11743-4264
US

V. Phone/Fax

Practice location:
  • Phone: 631-547-4100
  • Fax: 631-923-2907
Mailing address:
  • Phone: 631-547-4100
  • Fax: 631-923-2907

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: JEANINE AQUINO
Title or Position: VP SECRETATY
Credential:
Phone: 631-547-4100