MEDICARE: LIFESTYLE RECONSTRUCTION WEIGHT CONTROL CENTER

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1861128787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE RECONSTRUCTION WEIGHT CONTROL CENTER

Provider Business Mailing Address
First Line	:	125 S MAIN ST
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3501
Country	:	US
Telephone Number	:	845-271-9295
Fax Number	:	845-639-1959

Provider Business Practice Location Address
First Line	:	125 S MAIN ST
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3501
Country	:	US
Telephone Number	:	845-271-9295
Fax Number	:	845-639-1959

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	ROBIN KORNGOLD
Credential	:	LCSW, MSW
Telephone Number	:	845-271-9295

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	02/13/2026

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