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General NPI Number Information
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NPI Number | 1235581430
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Entity Type | Organization
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Legal Business Name | AGELESS MEN'S HEALTH HOLDINGS, PC CA
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 78 TODT HILL RD STE 205
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4528
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Country | US
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Telephone | 212-837-1946
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Fax | 212-837-1908
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Provider Business Mailing Address
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Address Line | 1847 VICTORY BLVD LOWER LEVEL
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3550
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Country | US
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Telephone | 212-837-1946
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Fax | 212-837-1908
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Authorized Official
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Title or Position | BUSINESS OPERATIONS DIRECTOR
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Name | AMANDA WILKINSON
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Credential |
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Telephone | 702-818-0446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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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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