Healthcare Provider Details

I. General information

NPI: 1073762035
Provider Name (Legal Business Name): BODY GUARDS NATURAL WEIGHT LOSS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E 76TH ST SUITE 12E
NEW YORK NY
10021-3138
US

IV. Provider business mailing address

530 E 76TH ST SUITE 12E
NEW YORK NY
10021-3138
US

V. Phone/Fax

Practice location:
  • Phone: 212-988-8108
  • Fax:
Mailing address:
  • Phone: 212-988-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SLATKIN
Title or Position: PRESIDENT
Credential:
Phone: 212-920-9776