Provider Demographics
NPI:1831700715
Name:TREE OF LIFE INTEGRATIVE FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:TREE OF LIFE INTEGRATIVE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKEILLA
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:SMITHBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-354-5553
Mailing Address - Street 1:532 OLD MARLTON PIKE W
Mailing Address - Street 2:PMB 752
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 NEW RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1306
Practice Address - Country:US
Practice Address - Phone:609-354-5553
Practice Address - Fax:609-438-7216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty