Provider Demographics
NPI:1972041143
Name:HEALTHY LIFE MD., LLC
Entity Type:Organization
Organization Name:HEALTHY LIFE MD., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHOBANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-515-9944
Mailing Address - Street 1:3840 PARK AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2563
Mailing Address - Country:US
Mailing Address - Phone:732-515-9944
Mailing Address - Fax:732-515-9945
Practice Address - Street 1:3840 PARK AVE STE 103
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2563
Practice Address - Country:US
Practice Address - Phone:732-515-9944
Practice Address - Fax:732-515-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty