MEDICARE: LIFESTYLE SOLUTIONS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467523985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	4346 WHITE PLAINS RD
Second Line	:	BRONX NEW YORK
City	:	BRONX
State	:	NY
Zip	:	10466-1408
Country	:	US
Telephone Number	:	718-231-7831
Fax Number	:	718-231-7851

Provider Business Practice Location Address
First Line	:	4346 WHITE PLAINS RD
Second Line	:	BRONX NEW YORK
City	:	BRONX
State	:	NY
Zip	:	10466-1408
Country	:	US
Telephone Number	:	718-231-7831
Fax Number	:	718-231-7851

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. VICTORIA KAY EHIGIATOR
Credential	:	B.H.S.
Telephone Number	:	17182317831

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	02/13/2008

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