Provider Demographics
NPI:1700448552
Name:LIFE BODY MEDICINE, PLLC
Entity Type:Organization
Organization Name:LIFE BODY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UNNIKRISHNAN
Authorized Official - Middle Name:NARAYANAN
Authorized Official - Last Name:THAMPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-395-1835
Mailing Address - Street 1:6 TUXEDO AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3519
Mailing Address - Country:US
Mailing Address - Phone:347-249-0768
Mailing Address - Fax:
Practice Address - Street 1:6 TUXEDO AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3519
Practice Address - Country:US
Practice Address - Phone:347-249-0768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty