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General NPI Number Information
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NPI Number | 1073009338
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Entity Type | Organization
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Legal Business Name | LIFETIME HEALTHCHOICE LLC
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 134 EVERGREEN PL STE 705
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City | EAST ORANGE
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State | NJ
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Zip | 07018-2012
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Country | US
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Telephone | 973-641-8836
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Fax | 973-695-3795
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Provider Business Mailing Address
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Address Line | 36 HAWTHORNE PL APT 4M
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3277
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Country | US
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Telephone | 973-641-8836
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MR. DENNIS YEBOAH KORDIE
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Credential | DNP
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Telephone | 973-641-8836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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