NPIMap

Organization Active NPI

Lifebridge Health and Fitness LLC

  • Registered Dietitian
  • Baltimore, MD
National Provider Identifier
1013117241
Registry record updated Sep 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
LIFEBRIDGE HEALTH AND FITNESS LLC
Practice address
1836 Greene Tree Rd
Baltimore, MD 21208-1381
Phone
(410) 484-6800
NPI assigned
Jul 25, 2007
Organization subpart
Yes
Parent organization
LIFEBRIDGE HEALTH & FITNESS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 12, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jared Fajerski
Title
Executive Director
Phone
(410) 318-6816

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X Primary
Cardiac Rehabilitation Clinic/Center 261QR0404X

Addresses

Primary practice location

1836 Greene Tree Rd
Baltimore, MD 21208-1381

Mailing address

1836 Greene Tree Rd
Baltimore, MD 21208-1381
Phone (410) 484-6800

National Provider Directory

National Provider Directory
Part of
Northwest Hospital

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378944000000",
    "number": "1013117241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 GREENE TREE RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212081381",
            "telephone_number": "410-484-6800",
            "fax_number": "410-484-6804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1836 GREENE TREE RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212081381",
            "telephone_number": "410-484-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE HEALTH AND FITNESS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFEBRIDGE HEALTH & FITNESS LLC",
        "enumeration_date": "2007-07-25",
        "last_updated": "2013-09-12",
        "status": "A",
        "authorized_official_last_name": "FAJERSKI",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "410-318-6816",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0404X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Cardiac Facilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.