Provider Demographics
NPI:1538547112
Name:HEALTHY LIVING FAMILY CARE CENTER
Entity type:Organization
Organization Name:HEALTHY LIVING FAMILY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-955-3232
Mailing Address - Street 1:84 SANFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1927
Mailing Address - Country:US
Mailing Address - Phone:862-955-3232
Mailing Address - Fax:862-772-4820
Practice Address - Street 1:84 SANFORD ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1927
Practice Address - Country:US
Practice Address - Phone:862-955-3232
Practice Address - Fax:862-772-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08826900173000000X
NJ25MP00192500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ426027Medicare PIN
LA1660789Medicare PIN