| | Physician Last Name: | New York Anti-Aging & Wellness Medical Services |
| | Physician First Name: | PLLC |
| | Physician Middle Name: | |
| | Address: | 821 Clove Road
Staten Island, NY 10310 |
| | License Number: | 215528 |
| | License Type: | |
| | Year of Birth: |
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| | Effective Date: | 06/06/2010 |
| | Action Description for DOH Webpage: | Revocation of certificate of incorporation. |
| | Misconduct Description for DOH Webpage: | The corporation agreed it could not successfully defend against at least one of the acts of failing to comply with state and federal law as defined in New York State Education Law Section 6530(16); receiving an improper fee from a third party and exercising undue influence on patients. |
| | License Limitations or Conditions for DOH Webpage: | |
| | Board Order: |
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