Provider Demographics
NPI:1376305847
Name:LIFEMD NEW ENGLAND PATIENT MEDICAL CARE PA
Entity Type:Organization
Organization Name:LIFEMD NEW ENGLAND PATIENT MEDICAL CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:YECIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-852-1575
Mailing Address - Street 1:236 5TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7606
Mailing Address - Country:US
Mailing Address - Phone:800-852-1575
Mailing Address - Fax:
Practice Address - Street 1:1209 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1120
Practice Address - Country:US
Practice Address - Phone:800-875-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty