Provider Demographics
NPI:1316692379
Name:LIVING WELL BALANCED NYC MEDICAL PLLC
Entity type:Organization
Organization Name:LIVING WELL BALANCED NYC MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELINE
Authorized Official - Middle Name:LATALIZA
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-727-4564
Mailing Address - Street 1:180 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6378
Mailing Address - Country:US
Mailing Address - Phone:212-579-2858
Mailing Address - Fax:
Practice Address - Street 1:180 W 80TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6378
Practice Address - Country:US
Practice Address - Phone:212-579-2858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty