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General NPI Number Information
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NPI Number | 1760749634
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Entity Type | Organization
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Legal Business Name | AGELESS MEN'S HEALTH
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Dates
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Enumeration Date | 04/17/2012
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 65 BROADWAY STE 1804
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City | NEW YORK
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State | NY
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Zip | 10006-2560
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Country | US
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Telephone | 212-430-6677
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Fax | 212-430-6678
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Provider Business Mailing Address
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Address Line | 65 BROADWAY STE 1804
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City | NEW YORK
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State | NY
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Zip | 10006-2560
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Country | US
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Telephone |
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Fax |
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 22 634573
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License Number State | NY
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