Provider Demographics
NPI:1760841472
Name:AGELESS BODY BY NEW SCIENCE LLC
Entity Type:Organization
Organization Name:AGELESS BODY BY NEW SCIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESAS
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:954-990-0302
Mailing Address - Street 1:2500 E HALLANDALE BEACH BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4837
Mailing Address - Country:US
Mailing Address - Phone:954-990-0302
Mailing Address - Fax:954-755-9347
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE 406
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4837
Practice Address - Country:US
Practice Address - Phone:954-990-0302
Practice Address - Fax:954-908-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11660111NN1001X
261QM1300X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1760841472OtherMEDICAL OFFICE
FL1760841472Medicaid