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General NPI Number Information
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NPI Number | 1528730876
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Entity Type | Organization
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Legal Business Name | AXIVA INFUSION CENTERS - PN LLC
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 10 ROUTE 31 N STE 103
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City | PENNINGTON
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State | NJ
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Zip | 08534-1606
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Country | US
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Telephone | 844-442-9482
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Fax | 844-440-0101
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Provider Business Mailing Address
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Address Line | 3420 FAIRLANE FARMS RD STE 200
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City | WELLINGTON
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State | FL
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Zip | 33414-8701
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Country | US
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Telephone | 561-955-0920
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Fax | 844-440-0101
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. COLLEEN S SHAPIRO
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Credential |
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Telephone | 561-955-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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