Provider Demographics
NPI:1629895107
Name:LIFEMD PUERTO RICO PATIENT MEDICAL CARE P.C.
Entity type:Organization
Organization Name:LIFEMD PUERTO RICO PATIENT MEDICAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:YECIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-263-3680
Mailing Address - Street 1:236 5TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7606
Mailing Address - Country:US
Mailing Address - Phone:800-852-1575
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE 1 STE 400
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1760
Practice Address - Country:US
Practice Address - Phone:800-852-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty