Healthcare Provider Details

I. General information

NPI: 1275915779
Provider Name (Legal Business Name): NAUGATUCK VALLEYWEIGHTLOSS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BOSTON POST RD
ORANGE CT
06477-3235
US

IV. Provider business mailing address

109 BOSTON POST RD
ORANGE CT
06477-3235
US

V. Phone/Fax

Practice location:
  • Phone: 203-891-0655
  • Fax: 866-581-0408
Mailing address:
  • Phone: 203-891-0655
  • Fax: 866-581-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number015130
License Number StateCT

VIII. Authorized Official

Name: DR. FRANK TRONCALE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 20387910611