Healthcare Provider Details

I. General information

NPI: 1013170257
Provider Name (Legal Business Name): LIVING WELL MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 BROADWAY SUITE 303
NEW YORK NY
10012-2614
US

IV. Provider business mailing address

632 BROADWAY SUITE 303
NEW YORK NY
10012-2614
US

V. Phone/Fax

Practice location:
  • Phone: 212-645-8151
  • Fax: 212-777-1653
Mailing address:
  • Phone: 212-645-8151
  • Fax: 212-777-1653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARNOLD BLANK
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 212-645-8151