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General NPI Number Information
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NPI Number | 1770778722
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Entity Type | Organization
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Legal Business Name | LIFE RX LLC
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 45 E 33RD ST SUITE 604
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City | NEW YORK
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State | NY
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Zip | 10016-5336
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Country | US
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Telephone | 212-447-0750
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Fax | 212-447-0751
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Provider Business Mailing Address
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Address Line | 45 E 33RD ST SUITE 604
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City | NEW YORK
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State | NY
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Zip | 10016-5336
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Country | US
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Telephone | 212-447-0750
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Fax | 212-447-0751
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Authorized Official
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Title or Position | CEO
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Name | DUMISANI KAMBI-SHAMBA
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Credential | MSTOM
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Telephone | 212-447-0750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 003586
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License Number State | NY
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