Healthcare Provider Details

I. General information

NPI: 1003563990
Provider Name (Legal Business Name): WEIGHT AND WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 PRINCETON HIGHTSTOWN RD BLDG C
EAST WINDSOR NJ
08512-2901
US

IV. Provider business mailing address

PO BOX 521
PRINCETON JUNCTION NJ
08550-0521
US

V. Phone/Fax

Practice location:
  • Phone: 609-269-5441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YINGZI DENG
Title or Position: OWNER
Credential: MD
Phone: 848-565-5345