Provider Demographics
NPI:1689146896
Name:HEALTHY LIVING, PC
Entity Type:Organization
Organization Name:HEALTHY LIVING, PC
Other - Org Name:HEALTHY LIVING FOR A HEALTHY LIFE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-239-1167
Mailing Address - Street 1:4 CYNTHIA CT
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-1612
Mailing Address - Country:US
Mailing Address - Phone:845-239-1167
Mailing Address - Fax:
Practice Address - Street 1:1715 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2526
Practice Address - Country:US
Practice Address - Phone:845-393-1167
Practice Address - Fax:888-960-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02426539Medicaid