# AGEWELL NEW YORK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740520949
- **Authorized official:** MS. TARA BUONOCORE-RUT (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (718) 289-2669

## Contact information

- **Practice address:** 27111 76TH AVE, NEW HYDE PARK, NY 11040-1436
- **Practice address phone:** (866) 586-8044
- **Practice address fax:** (855) 366-4110
- **Mailing address:** 27111 76TH AVE, NEW HYDE PARK, NY 11040-1436
- **Mailing address phone:** (866) 586-8044
- **Mailing address fax:** (855) 366-4110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 02/25/2013
- **Last updated:** 02/25/2013