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General NPI Number Information
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NPI Number | 1891080800
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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 | 06/17/2011
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 161 ATLANTIC AVE FL 2
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City | BROOKLYN
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State | NY
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Zip | 11201-6792
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Country | US
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Telephone | 212-430-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 161 ATLANTIC AVE FL 2
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City | BROOKLYN
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State | NY
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Zip | 11201-6792
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Country | US
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Telephone | 212-430-6677
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0068091
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License Number State | NY
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