Healthcare Provider Details

I. General information

NPI: 1205588324
Provider Name (Legal Business Name): ANSIBLE PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 CENTRAL PARK AVE STE 300
VIRGINIA BEACH VA
23462-3271
US

IV. Provider business mailing address

249 CENTRAL PARK AVE STE 300
VIRGINIA BEACH VA
23462-3271
US

V. Phone/Fax

Practice location:
  • Phone: 877-267-4253
  • Fax: 877-395-9003
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN WINIARSKI
Title or Position: PRESIDENT
Credential: DO
Phone: 877-267-4253