Agewell New York, LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

AGEWELL NEW YORK, LLC

Practice address

27111 76TH Ave
New Hyde Park, NY 11040-1436

Phone

(866) 586-8044

Fax

(855) 366-4110

NPI assigned

Feb 25, 2013

Last updated

Feb 25, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Tara Buonocore-Rut

Title

Executive Director

Phone

(718) 289-2669

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1361750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361750400000",
    "number": "1740520949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27111 76TH AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401436",
            "telephone_number": "866-586-8044",
            "fax_number": "855-366-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27111 76TH AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401436",
            "telephone_number": "866-586-8044",
            "fax_number": "855-366-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGEWELL NEW YORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-25",
        "last_updated": "2013-02-25",
        "status": "A",
        "authorized_official_last_name": "BUONOCORE-RUT",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "718-289-2669",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03481927",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Alpna Aggarwal, D.O.
• Abhinav Agrawal, M.D.
• Mayank Agrawal, M.D.
• Neelima Agrawal
• Vishesh Agrawal, M.D.

• Health Maintenance Organization in New Hyde Park, NY
• Providers in New Hyde Park, NY by specialty
• Health Maintenance Organization in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; 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.