Agewell Diagnostics, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

015532-1 Issued in NY

Legal business name

AGEWELL DIAGNOSTICS, INC.

Practice address

1999 Marcus Avenue
Suite M15
Lake Success, NY 11042

Phone

(516) 488-8808

Fax

(516) 488-8808

NPI assigned

Apr 30, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark Herbrich, PT

Title

Owner/PT

Phone

(516) 488-8808

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525046400000",
    "number": "1366930836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1999 MARCUS AVENUE",
            "address_2": "SUITE M15",
            "city": "LAKE SUCCESS",
            "state": "NY",
            "postal_code": "11042",
            "telephone_number": "516-488-8808",
            "fax_number": "516-488-8808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1999 MARCUS AVENUE",
            "address_2": "SUITE M15",
            "city": "LAKE SUCCESS",
            "state": "NY",
            "postal_code": "11042",
            "telephone_number": "516-488-8808",
            "fax_number": "516-488-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGEWELL DIAGNOSTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-30",
        "last_updated": "2018-04-30",
        "status": "A",
        "authorized_official_last_name": "HERBRICH",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER/PT",
        "authorized_official_telephone_number": "516-488-8808",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "015532-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Milena Alicandro, OTR/L
• Steven Allen

• Physical Therapist in Lake Success, NY
• Providers in Lake Success, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.