=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972395416
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INVIGORATE WELLNESS LI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2025
-----------------------------------------------------
Last Update Date | 05/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 E MIDDLE COUNTRY RD STE 1
-----------------------------------------------------
City | SMITHTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11787-2822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-278-4516
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 CLOVER MEADOW CT
-----------------------------------------------------
City | HOLTSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11742-2565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-278-4516
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMY FERRARA
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 631-278-4516
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------