Healthcare Provider Details

I. General information

NPI: 1003455767
Provider Name (Legal Business Name): OMEGA WEIGHT LOSS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S ORANGE AVE
SOUTH ORANGE NJ
07079-2202
US

IV. Provider business mailing address

228 S ORANGE AVE
SOUTH ORANGE NJ
07079-2202
US

V. Phone/Fax

Practice location:
  • Phone: 973-821-5058
  • Fax: 973-821-5059
Mailing address:
  • Phone: 973-821-5058
  • Fax: 973-821-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DUANE FREDERICKS
Title or Position: OWNER
Credential: MD
Phone: 347-268-0114