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General NPI Number Information
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NPI Number | 1871935254
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Entity Type | Organization
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Legal Business Name | LIFEWAYS NUTRITION, PLLC
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 261 E 78TH ST 6TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10075-1216
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Country | US
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Telephone | 646-520-9751
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Fax |
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Provider Business Mailing Address
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Address Line | 170 E 89TH ST SUITE 4E
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City | NEW YORK
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State | NY
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Zip | 10128-2311
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Country | US
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Telephone | 646-386-7745
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Fax |
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Authorized Official
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Title or Position | CLINICAL NUTRITION MANAGER
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Name | MS. DEBORAH ANN CARDILE
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Credential | M.S., CDN
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Telephone | 646-520-9751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 002215
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License Number State | NY
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