Provider Demographics
NPI:1730716937
Name:PREVENTIVE LIFESTYLE ASSISTANCE NETWORK MARCI KENON SOLE MBR
Entity type:Organization
Organization Name:PREVENTIVE LIFESTYLE ASSISTANCE NETWORK MARCI KENON SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/DPP CERTIFIED COACH
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:KENON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-389-0063
Mailing Address - Street 1:1309 5TH AVE APT 25E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3127
Mailing Address - Country:US
Mailing Address - Phone:646-389-0063
Mailing Address - Fax:479-777-8056
Practice Address - Street 1:101 W 123RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5511
Practice Address - Country:US
Practice Address - Phone:212-662-5536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty