| Lifeback Llc | |
|
4 Princess Rd Bldg 200 / Suite 206 Lawrenceville NJ 08648-2322 | |
| (609) 482-3701 | |
| (215) 975-7300 |
| Full Name | Lifeback Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4 Princess Rd, Lawrenceville, New Jersey |
| Authorized Official Name and Position | Marinetta Serotte (ADMINSTRATOR/OWNER) |
| Authorized Official Contact | 6098728021 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeback Llc 3366 Durham Rd Doylestown PA 18902-1817 Ph: () - | Lifeback Llc 4 Princess Rd Bldg 200 / Suite 206 Lawrenceville NJ 08648-2322 Ph: (609) 482-3701 |
| NPI Number | 1780015412 |
|---|---|
| Provider Enumeration Date | 12/05/2013 |
| Last Update Date | 05/30/2023 |
| Medicare PECOS PAC ID | 7214396613 |
|---|---|
| Medicare Enrollment ID | O20230703001729 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780015412 | NPI | - | NPPES |
| Provider Name | Firoz P Rahman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053351080 PECOS PAC ID: 9830121508 Enrollment ID: I20090813000384 |
| Provider Name | Joan Audrey Galkin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700053840 PECOS PAC ID: 3274992680 Enrollment ID: I20230703001925 |
| Provider Name | Adam G Blake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609437227 PECOS PAC ID: 6406217694 Enrollment ID: I20230803004048 |
| Provider Name | Gregory K Smola |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124674841 PECOS PAC ID: 2264894013 Enrollment ID: I20230811000217 |
| Provider Name | Stephan Brautigam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215392550 PECOS PAC ID: 0840698593 Enrollment ID: I20230823000160 |
| Provider Name | Julia Tokar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891261079 PECOS PAC ID: 7315394384 Enrollment ID: I20231113002631 |
| Provider Name | Emily Jalajas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073152765 PECOS PAC ID: 6709233042 Enrollment ID: I20231118000204 |
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