Organization
LIFESTYLES MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAND SALANI (ADMIN)
(732) 542-2638
Entity
Organization
Contact information
Practice address
107 MONMOUTH RD, SUITE 104 D, WEST LONG BRANCH, NJ 07764-1021
(732) 542-2638
(732) 542-2620
Mailing address
107 MONMOUTH RD, SUITE 104 D, WEST LONG BRANCH, NJ 07764-1021
(732) 542-2638
(732) 542-2620
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
44SC05539700
NJ
208D00000X
General Practice Physician
Primary
25MB07769000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0600410687
CORPORATE ID NUMBER
NJ
Enumeration date
06/10/2014
Last updated
06/10/2014
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