Provider Demographics
NPI:1073762035
Name:BODY GUARDS NATURAL WEIGHT LOSS, LLC
Entity Type:Organization
Organization Name:BODY GUARDS NATURAL WEIGHT LOSS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-920-9776
Mailing Address - Street 1:530 E 76TH ST
Mailing Address - Street 2:SUITE 12E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3138
Mailing Address - Country:US
Mailing Address - Phone:212-988-8108
Mailing Address - Fax:
Practice Address - Street 1:530 E 76TH ST
Practice Address - Street 2:SUITE 12E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3138
Practice Address - Country:US
Practice Address - Phone:212-988-8108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization