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General NPI Number Information
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NPI Number | 1164100657
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Entity Type | Organization
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Legal Business Name | LIFEMD ATLANTIC PATIENT MEDICAL CARE PC
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 221 RIVER ST STE 9
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City | HOBOKEN
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State | NJ
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Zip | 07030-5990
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Country | US
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Telephone | 646-263-3680
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Fax |
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Provider Business Mailing Address
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Address Line | 236 5TH AVE STE 400
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City | NEW YORK
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State | NY
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Zip | 10001-7606
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Country | US
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Telephone | 800-852-5175
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Fax |
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Authorized Official
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Title or Position | CCO
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Name | ERIC YECIES
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Credential |
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Telephone | 800-852-1575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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