Provider Demographics
NPI: | 1164737706 |
---|---|
Name: | LIFE CYCLES OBGYN LLC |
Entity Type: | Organization |
Organization Name: | LIFE CYCLES OBGYN LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/ PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | YAEL |
Authorized Official - Middle Name: | JENNIFER |
Authorized Official - Last Name: | ANTEBI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 917-902-1129 |
Mailing Address - Street 1: | 3 DOROTHY AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LIVINGSTON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07039-2003 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 917-902-1129 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3 DOROTHY AVE |
Practice Address - Street 2: | |
Practice Address - City: | LIVINGSTON |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07039-2003 |
Practice Address - Country: | US |
Practice Address - Phone: | 917-902-1129 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-08-06 |
Last Update Date: | 2010-08-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 25MA08600100 | 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Single Specialty |