Healthcare Provider Details

I. General information

NPI: 1942480132
Provider Name (Legal Business Name): NUTRITION AND WEIGHT MANAGEMENT CENTER OF FAIRFIELD COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TECHNOLOGY DR STE B-106
TRUMBULL CT
06611-6337
US

IV. Provider business mailing address

115 TECHNOLOGY DR STE B-106
TRUMBULL CT
06611-6337
US

V. Phone/Fax

Practice location:
  • Phone: 203-692-2180
  • Fax: 203-452-1412
Mailing address:
  • Phone: 203-692-2180
  • Fax: 203-452-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number000380
License Number StateCT

VIII. Authorized Official

Name: MRS. INDU GUPTA
Title or Position: OFFICE MANAGER
Credential:
Phone: 203-692-2180