Provider Demographics
NPI:1003236589
Name:JOUVENCE LLC
Entity Type:Organization
Organization Name:JOUVENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LODZE
Authorized Official - Middle Name:
Authorized Official - Last Name:STECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-254-3091
Mailing Address - Street 1:277 PIPING ROCK RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-2504
Mailing Address - Country:US
Mailing Address - Phone:781-254-3091
Mailing Address - Fax:
Practice Address - Street 1:277 PIPING ROCK RD
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-2504
Practice Address - Country:US
Practice Address - Phone:781-254-3091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2564502086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty