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Organization
AGEWELL NEW YORK, LLC
Active
Organization
AGEWELL NEW YORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TARA BUONOCORE-RUT (EXECUTIVE DIRECTOR)
(718) 289-2669
Entity
Organization
Contact information
Practice address
27111 76TH AVE, NEW HYDE PARK, NY 11040-1436
(866) 586-8044
(855) 366-4110
Mailing address
27111 76TH AVE, NEW HYDE PARK, NY 11040-1436
(866) 586-8044
(855) 366-4110
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
NULL
Other
Enumeration date
02/25/2013
Last updated
02/25/2013
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