Provider Demographics
NPI:1740069269
Name:ERNIT LIFESTYLE LLC
Entity type:Organization
Organization Name:ERNIT LIFESTYLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-264-8701
Mailing Address - Street 1:26 ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2402
Mailing Address - Country:US
Mailing Address - Phone:201-264-8701
Mailing Address - Fax:
Practice Address - Street 1:544 MOUNT HOPE RD
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:NJ
Practice Address - Zip Code:07885-2816
Practice Address - Country:US
Practice Address - Phone:973-532-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care