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General NPI Number Information
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NPI Number | 1235004904
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Entity Type | Organization
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Legal Business Name | NEUAGE LSL LLC
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 6105 RONALD REAGAN DR
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-2678
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Country | US
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Telephone | 314-721-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 6105 RONALD REAGAN DR
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-2678
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Country | US
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Telephone | 314-721-9990
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN ALIBERTI
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Credential |
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Telephone | 314-220-0272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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