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General NPI Number Information
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NPI Number | 1164737706
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Entity Type | Organization
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Legal Business Name | LIFE CYCLES OBGYN LLC
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 3 DOROTHY AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-2003
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Country | US
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Telephone | 917-902-1129
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Fax |
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Provider Business Mailing Address
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Address Line | 3 DOROTHY AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-2003
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Country | US
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Telephone | 917-902-1129
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Fax |
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | DR. YAEL JENNIFER ANTEBI
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Credential | MD
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Telephone | 917-902-1129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA08600100
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License Number State | NJ
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