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General NPI Number Information
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NPI Number | 1205153251
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIONS PHYSICIANS WEIGHT MANAGEMENT LLC
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Dates
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Enumeration Date | 04/30/2010
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 719 HIGHWAY 206 SUITE 101
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1536
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Country | US
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Telephone | 908-281-6771
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Fax | 908-281-6439
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Provider Business Mailing Address
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Address Line | 719 HIGHWAY 206 SUITE 101
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1536
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Country | US
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Telephone | 908-281-6771
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Fax | 908-281-6439
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KATHLEEN ANN HICKEY
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Credential | M.D.
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Telephone | 908-281-6771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NN09992000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | MA067366
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License Number State | NJ
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