Provider Demographics
NPI:1871935254
Name:LIFEWAYS NUTRITION, PLLC
Entity type:Organization
Organization Name:LIFEWAYS NUTRITION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NUTRITION MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARDILE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CDN
Authorized Official - Phone:646-520-9751
Mailing Address - Street 1:170 E 89TH ST
Mailing Address - Street 2:SUITE 4E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2311
Mailing Address - Country:US
Mailing Address - Phone:646-386-7745
Mailing Address - Fax:
Practice Address - Street 1:261 E 78TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1216
Practice Address - Country:US
Practice Address - Phone:646-520-9751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002215133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty