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General NPI Number Information
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NPI Number | 1275372302
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Entity Type | Organization
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Legal Business Name | LIFELONG WELLNESS OF OHIO LLC
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 31054 STATE ROUTE 93
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City | MC ARTHUR
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State | OH
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Zip | 45651-8925
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Country | US
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Telephone | 732-691-0470
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Fax |
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Provider Business Mailing Address
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Address Line | 1074 TIMES SQUARE BLVD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5524
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Country | US
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Telephone | 732-691-0470
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ISRAEL STEIN
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Credential |
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Telephone | 732-691-0470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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