Provider Demographics
NPI:1669689808
Name:HEALTHY LIFE MEDICAL PC
Entity type:Organization
Organization Name:HEALTHY LIFE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVSHALUMOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-646-3750
Mailing Address - Street 1:1120 BRIGHTON BEACH AVE
Mailing Address - Street 2:SUITE 6 0
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-646-3750
Mailing Address - Fax:718-646-3877
Practice Address - Street 1:1120 BRIGHTON BEACH AVE
Practice Address - Street 2:SUITE 6 0
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-646-3750
Practice Address - Fax:718-646-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty