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General NPI Number Information
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NPI Number | 1972175586
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Entity Type | Organization
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Legal Business Name | AGBS OPTIMAL HEALTH LLC
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Dates
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Enumeration Date | 07/13/2021
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 10 ALTA DR
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City | BRONXVILLE
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State | NY
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Zip | 10708-4503
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Country | US
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Telephone | 646-294-8783
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Fax | 888-727-0593
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Provider Business Mailing Address
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Address Line | 10 ALTA DR
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City | BRONXVILLE
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State | NY
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Zip | 10708-4503
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Country | US
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Telephone | 646-294-8783
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Fax | 888-727-0593
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA BROWN
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Credential |
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Telephone | 646-294-8783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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