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General NPI Number Information
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NPI Number | 1730716937
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Entity Type | Organization
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Legal Business Name | PREVENTIVE LIFESTYLE ASSISTANCE NETWORK MARCI KENON SOLE MBR
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 101 W 123RD ST
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City | NEW YORK
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State | NY
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Zip | 10027-5511
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Country | US
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Telephone | 212-662-5536
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 5TH AVE APT 25E
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City | NEW YORK
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State | NY
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Zip | 10029-3127
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Country | US
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Telephone | 646-389-0063
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Fax | 479-777-8056
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Authorized Official
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Title or Position | FOUNDER/DPP CERTIFIED COACH
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Name | MARCI KENON
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Credential |
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Telephone | 646-389-0063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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