Provider Demographics
NPI:1174396873
Name:LIFESTYLE MEDLY, LLC
Entity type:Organization
Organization Name:LIFESTYLE MEDLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-844-9062
Mailing Address - Street 1:2650 US HIGHWAY 130 STE B
Mailing Address - Street 2:
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-3327
Mailing Address - Country:US
Mailing Address - Phone:201-844-9062
Mailing Address - Fax:
Practice Address - Street 1:2650 ROUTE 130 STE B
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3327
Practice Address - Country:US
Practice Address - Phone:201-844-9062
Practice Address - Fax:201-365-5737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty