FOUNTAIN OF YOUTH RX LLC (NPI# 1265860530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265860530 |
| Entity Type | Organization |
| Organization Name | FOUNTAIN OF YOUTH RX LLC |
| Practice Address |
1 Station Plz Ridgefield Park NJ 07660-1605 |
| Mailing Address |
22 Byrne Pl Bergenfield NJ 07621-1002 |
| Practice Telephone | 3475850208 |
| Mailing Telephone | 3475850208 |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2020-08-26 |
| Authorized Official Name | DR. DAVID PETER SUAREZ (OWNER/MEDICAL DIRECTOR) |
| Authorized Official Telephone | 3475850208 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 245996-1 | NY | Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | Fountain of Youth Rx LLC | 89 Laddins Rock Rd., Old Greenwich, CT 06870 |
| New York State Corporations | FOUNTAIN OF YOUTH RX LLC | 3733 Richmond Avenue, Suite 1a, Staten Island, Ny 10312 |
| Street Address |
1 STATION PLZ |
| City | RIDGEFIELD PARK |
| State | NJ |
| Zip Code | 07660-1605 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033675681 | Suarez Health Medical Pllc | Surgery | 1 Station Plz, Ridgefield Park, NJ 07660-1605 | 2019-02-19 |
| 1144786732 | Pure Wellness Medical Pllc | Surgery | 1 Station Plz, Ridgefield Park, NJ 07660-1605 | 2019-02-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053967067 | Clare Maggio | Technician | 114 Third Street, Ridgefield Park, NJ 07660 | 2019-08-15 |
| 1427528090 | Beatriz Cruz | Social Worker | 395 Grand Street, Jersey City, NJ 07660 | 2018-11-27 |
| 1689102014 | Kyle James Viola | Physician Assistant | 714 10th St., Secaucus, NJ 07660 | 2017-05-30 |
| 1306398391 | Lawton C Thomas Jr D.m.d | Clinic/Center | 288 Main Street, Rdgefield Park, NJ 07660 | 2016-10-26 |
| 1396130316 | George Mina | Podiatrist | 199 Bergen Tpke Apt 2c, Ridgefield Park, NJ 07660 | 2015-04-06 |
| 1346582236 | Daniel Rousseau | Registered Nurse | 147 Hobart Street, Ridgiefiel Park, NJ 07660 | 2013-03-19 |
| 1275796138 | Aquaentellius, Inc | Pharmacy | 17 7th Street, Ridgefield Park, NJ 07660 | 2008-07-09 |
| 1487872495 | Nina Izhaky | Dentist | 45 Winant Ave., Ridgefield Park, NJ 07660 | 2007-04-23 |
| 1518987726 | Sonmed Homecare, LLC | Durable Medical Equipment & Medical Supplies | 58 60 Ridgefield Ave, Suite 6, Ridgefield Park, NJ 07660 | 2006-07-20 |
| 1811262330 | Iram Aqeel | Internal Medicine | 870 Palisade Ave, Teaneck, NJ 07660 | 2012-03-16 |
| Find all providers in zip 07660 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033675681 | Suarez Health Medical Pllc | Surgery | 1 Station Plz, Ridgefield Park, NJ 07660-1605 | 2019-02-19 |
| 1144786732 | Pure Wellness Medical Pllc | Surgery | 1 Station Plz, Ridgefield Park, NJ 07660-1605 | 2019-02-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861002867 | Herrmann Rnfa LLC | Surgery | 37 Center Ave, Cedar Grove, NJ 07009-1015 | 2020-08-04 |
| 1003437492 | New Jersey Robotic Surgery Associates PC | Surgery | 114 Essex St Ste 102, Rochelle Park, NJ 07662-4342 | 2020-04-27 |
| 1386273803 | Felere Cherfils | Surgery | 10 Wyckoff Dr, Pittstown, NJ 08867-4236 | 2020-04-06 |
| 1841829983 | Naeem Patel | Surgery | 1209 89th St, North Bergen, NJ 07047-4462 | 2020-04-01 |
| 1184255119 | Impact Medical & Diagnostics of Nj PC | Surgery | 145 N Franklin Tpke Ste 106, Ramsey, NJ 07446-1634 | 2020-01-29 |
| 1598316143 | Heritage Laparoscopy Acute Care Surgery PC | Surgery | 9 Post Rd Ste M7, Oakland, NJ 07436-1615 | 2019-09-25 |
| 1013570506 | Atlanticare Center for Orthopedic Surgery | Surgery | 2500 English Creek Ave Ste 1201, Egg Harbor Twp, NJ 08234-5549 | 2019-04-19 |
| 1881157550 | Somerset Surgical Associates,llc | Surgery | 575 Route 28 # 3107, Raritan, NJ 08869-1354 | 2019-04-10 |
| 1154884203 | Buchholz Bariatrics | Surgery | 1647 Bay Ave, Point Pleasant Boro, NJ 08742-4501 | 2019-04-07 |
| 1023589553 | L.i.v. Medical Hydration Therapy LLC | Surgery | 201 3rd Ave Apt 3b, Belmar, NJ 07719-2050 | 2018-12-10 |
| Find all providers with the same taxonomy | ||||
| City | RIDGEFIELD PARK |
| Zip Code | 07660 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.