Provider Demographics
NPI:1467523985
Name:LIFESTYLE SOLUTIONS, INC.
Entity Type:Organization
Organization Name:LIFESTYLE SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:EHIGIATOR
Authorized Official - Suffix:
Authorized Official - Credentials:BHS
Authorized Official - Phone:1718-231-7831
Mailing Address - Street 1:4346 WHITE PLAINS RD
Mailing Address - Street 2:BRONX NEW YORK
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1408
Mailing Address - Country:US
Mailing Address - Phone:718-231-7831
Mailing Address - Fax:718-231-7851
Practice Address - Street 1:4346 WHITE PLAINS RD
Practice Address - Street 2:BRONX NEW YORK
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1408
Practice Address - Country:US
Practice Address - Phone:718-231-7831
Practice Address - Fax:718-231-7851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02573706Medicaid