Healthcare Provider Details

I. General information

NPI: 1104510791
Provider Name (Legal Business Name): LIFEMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N CENTRAL AVE STE 460
PHOENIX AZ
85012-1995
US

IV. Provider business mailing address

236 5TH AVE STE 400
NEW YORK NY
10001-7606
US

V. Phone/Fax

Practice location:
  • Phone: 800-852-1575
  • Fax:
Mailing address:
  • Phone: 800-852-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC YECIES
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 646-263-3680