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General NPI Number Information
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NPI Number | 1134066756
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Entity Type | Organization
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Legal Business Name | LIFEWELL MEDICAL PA
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Dates
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Enumeration Date | 05/01/2026
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Last Update Date | 05/01/2026
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Provider Practice Location Address
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Address Line | 220 9TH ST
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City | PORT SAINT JOE
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State | FL
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Zip | 32456-1924
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Country | US
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Telephone | 845-360-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 23 ROBERT PITT DR STE 102A
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City | MONSEY
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State | NY
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Zip | 10952-3470
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YITZCHAK GOLDSMITH
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Credential | DO
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Telephone | 845-360-2552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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