Provider Demographics
NPI:1477357457
Name:LIFESTYLE MEDICINE NEW HAVEN LLC
Entity type:Organization
Organization Name:LIFESTYLE MEDICINE NEW HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKOYE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-859-4476
Mailing Address - Street 1:61 LOOMIS PL
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2222
Mailing Address - Country:US
Mailing Address - Phone:347-681-7196
Mailing Address - Fax:
Practice Address - Street 1:496 NEWHALL ST STE 206
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-3248
Practice Address - Country:US
Practice Address - Phone:203-859-4476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service