NPIMap

Organization Active NPI

Living Well Balanced Nyc Medical PLLC

  • Internal Medicine Physician
  • New York, NY
National Provider Identifier
1316692379
Registry record updated Feb 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LIVING WELL BALANCED NYC MEDICAL PLLC
Practice address
180 W 80TH St
New York, NY 10024-6378
Phone
(212) 579-2858
NPI assigned
Feb 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2022

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

Authorized official

Name
Micheline Lataliza Epstein, MDNPI 1417245382
Title
Owner
Phone
(214) 727-4564

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

180 W 80TH St
New York, NY 10024-6378

Mailing address

180 W 80TH St
New York, NY 10024-6378
Phone (212) 579-2858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220413000458 NY Part B Supplier - Clinic/Group Practice 8224424544 Receives reassigned benefits from 8 practitioners
Practice locations: New York, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1645142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645142400000",
    "number": "1316692379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 W 80TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100246378",
            "telephone_number": "212-579-2858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 W 80TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100246378",
            "telephone_number": "212-579-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELL BALANCED NYC MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-18",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A",
        "authorized_official_last_name": "EPSTEIN",
        "authorized_official_first_name": "MICHELINE",
        "authorized_official_middle_name": "LATALIZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-727-4564",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.