Provider Demographics
NPI:1871311068
Name:INNOVAFUSE INFUSION SERVICES, LLC
Entity type:Organization
Organization Name:INNOVAFUSE INFUSION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAJLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-636-5775
Mailing Address - Street 1:6900 JERICHO TPKE STE 100W
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4457
Mailing Address - Country:US
Mailing Address - Phone:516-636-5775
Mailing Address - Fax:516-636-5785
Practice Address - Street 1:6900 JERICHO TPKE STE 100W
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4457
Practice Address - Country:US
Practice Address - Phone:516-636-5775
Practice Address - Fax:516-636-5785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy