Provider Demographics
NPI:1154892909
Name:LIFE CYCLES CLINIC
Entity type:Organization
Organization Name:LIFE CYCLES CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:518-504-6600
Mailing Address - Street 1:288 SOUTH RIVER ROAD
Mailing Address - Street 2:BLDG A, UNIT 1
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-399-6600
Mailing Address - Fax:617-221-9734
Practice Address - Street 1:839 NEW LOUDON RD STE 1
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-6101
Practice Address - Country:US
Practice Address - Phone:518-504-6600
Practice Address - Fax:617-221-9734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750837092OtherNPI