Provider Demographics
NPI:1578256574
Name:THE CENTER FOR CANCER LIFESTYLE MANAGEMENT
Entity Type:Organization
Organization Name:THE CENTER FOR CANCER LIFESTYLE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-450-4625
Mailing Address - Street 1:308 W 97TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6123
Mailing Address - Country:US
Mailing Address - Phone:917-450-4625
Mailing Address - Fax:
Practice Address - Street 1:308 W 97TH ST APT 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6123
Practice Address - Country:US
Practice Address - Phone:917-450-4625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, OncologyGroup - Multi-Specialty