Provider Demographics
NPI:1124209093
Name:MEDICAL WEIGHT LOSS AND HEALTHCARE
Entity Type:Organization
Organization Name:MEDICAL WEIGHT LOSS AND HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAN
Authorized Official - Middle Name:WEI
Authorized Official - Last Name:MENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-689-7546
Mailing Address - Street 1:338 HARRIS HILL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7407
Mailing Address - Country:US
Mailing Address - Phone:716-634-4798
Mailing Address - Fax:716-634-0987
Practice Address - Street 1:8770 TRANSIT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1840
Practice Address - Country:US
Practice Address - Phone:716-689-7546
Practice Address - Fax:716-634-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherUNITED HEALTHCARE/EMPIRE
NY=========OtherUNITED HEALTHCARE/EMPIRE