Provider Demographics
NPI:1396285706
Name:LIFEFIT WELLNESS LLC
Entity type:Organization
Organization Name:LIFEFIT WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:551-358-2425
Mailing Address - Street 1:26 JACOBUS AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2305
Mailing Address - Country:US
Mailing Address - Phone:551-358-2425
Mailing Address - Fax:
Practice Address - Street 1:26 JACOBUS AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-2305
Practice Address - Country:US
Practice Address - Phone:551-358-2425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health