Provider Demographics
NPI:1356177448
Name:DE-SENESCE LLC
Entity type:Organization
Organization Name:DE-SENESCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SPINOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-580-0207
Mailing Address - Street 1:1361 13TH AVE S STE 170
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3235
Mailing Address - Country:US
Mailing Address - Phone:904-580-0207
Mailing Address - Fax:
Practice Address - Street 1:1361 13TH AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3233
Practice Address - Country:US
Practice Address - Phone:904-580-0207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Single Specialty