Provider Demographics
NPI:1689130114
Name:LIFE TECH, INC
Entity Type:Organization
Organization Name:LIFE TECH, INC
Other - Org Name:LIFE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-626-2350
Mailing Address - Street 1:70 S ORANGE AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4911
Mailing Address - Country:US
Mailing Address - Phone:973-273-3441
Mailing Address - Fax:
Practice Address - Street 1:70 S ORANGE AVE STE 220
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4911
Practice Address - Country:US
Practice Address - Phone:973-273-3441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1740774504Medicaid