Healthcare Provider Details

I. General information

NPI: 1912450008
Provider Name (Legal Business Name): LIVINGSTON 1 WEIGHTLOSS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REGENT ST SUITE 509
LIVINGSTON NJ
07039-1675
US

IV. Provider business mailing address

5 REGENT ST SUITE 509
LIVINGSTON NJ
07039-1675
US

V. Phone/Fax

Practice location:
  • Phone: 973-251-2437
  • Fax: 973-251-2654
Mailing address:
  • Phone: 973-251-2437
  • Fax: 973-251-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WENDIE NONCLERC
Title or Position: DIRECTOR OF INSURANCE DEVELOPMENT
Credential:
Phone: 813-228-6334