Organization
AGEWELL DIAGNOSTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK HERBRICH PT (OWNER/PT)
(516) 488-8808
Entity
Organization
Contact information
Practice address
1999 MARCUS AVENUE, SUITE M15, LAKE SUCCESS, NY 11042
(516) 488-8808
(516) 488-8808
Mailing address
1999 MARCUS AVENUE, SUITE M15, LAKE SUCCESS, NY 11042
(516) 488-8808
(516) 488-8808
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
015532-1
NY
Other
Enumeration date
04/30/2018
Last updated
04/30/2018
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