Individual
IRENE AGIVAIVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
262 SHOTWELL AVE, STATEN ISLAND, NY 10312-1963
(929) 335-3712
(888) 679-5645
Mailing address
262 SHOTWELL AVENUE, STATEN ISLAND, NY 10312
(929) 335-3712
(888) 679-5645
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04606268
—
NY
Enumeration date
08/09/2017
Last updated
07/21/2022
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