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General NPI Number Information
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NPI Number | 1477357457
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Entity Type | Organization
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Legal Business Name | LIFESTYLE MEDICINE NEW HAVEN LLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 496 NEWHALL ST STE 206
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City | HAMDEN
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State | CT
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Zip | 06517-3248
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Country | US
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Telephone | 203-859-4476
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Fax |
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Provider Business Mailing Address
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Address Line | 61 LOOMIS PL
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City | NEW HAVEN
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State | CT
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Zip | 06511-2222
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Country | US
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Telephone | 347-681-7196
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Fax |
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Authorized Official
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Title or Position | CEO AND FOUNDER
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Name | MRS. IFEOMA NWOKOYE
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Credential | APRN
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Telephone | 203-859-4476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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