Provider Demographics
NPI:1487026332
Name:WELLNESS NORWALK, INC
Entity Type:Organization
Organization Name:WELLNESS NORWALK, INC
Other - Org Name:MEDI-WEIGHTLOSS CLINIC OF WILTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAUGAVIETIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-894-3881
Mailing Address - Street 1:70 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4408
Mailing Address - Country:US
Mailing Address - Phone:203-349-6334
Mailing Address - Fax:
Practice Address - Street 1:70 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4408
Practice Address - Country:US
Practice Address - Phone:203-349-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty