Healthcare Provider Details

I. General information

NPI: 1205153251
Provider Name (Legal Business Name): TRANSFORMATIONS PHYSICIANS WEIGHT MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 HIGHWAY 206 SUITE 101
HILLSBOROUGH NJ
08844-1536
US

IV. Provider business mailing address

719 HIGHWAY 206 SUITE 101
HILLSBOROUGH NJ
08844-1536
US

V. Phone/Fax

Practice location:
  • Phone: 908-281-6771
  • Fax: 908-281-6439
Mailing address:
  • Phone: 908-281-6771
  • Fax: 908-281-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberMA067366
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN09992000
License Number StateNJ

VIII. Authorized Official

Name: DR. KATHLEEN ANN HICKEY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 908-281-6771