NPI 1154789683

Awixa Home of Li, INC

Organisation Preferred Provider Organization Bay Shore, NY

Practice location

Address: 199 Benton Pl, Bay Shore, NY 11706-1507
Phone: (516) 882-9492
Fax: (516) 882-9494
Mailing address: 301 Clearview Ln, Massapequa, NY 11758-8505

Authorised official

Name: Alyse Robin Cardello
Title: Ceo
Phone: (516) 882-9492

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

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Registry record

NPI: 1154789683
Entity type: Organization
NPI issued: 28 Jan 2016
Record last updated: 28 Jan 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.