Provider Demographics
NPI:1619147311
Name:PEDIATRIC WEIGHT MANAGEMENT CENTERS LLC
Entity Type:Organization
Organization Name:PEDIATRIC WEIGHT MANAGEMENT CENTERS LLC
Other - Org Name:GREAT MOVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-928-0006
Mailing Address - Street 1:188 NEEDHAM ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1596
Mailing Address - Country:US
Mailing Address - Phone:617-928-0006
Mailing Address - Fax:
Practice Address - Street 1:188 NEEDHAM ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1596
Practice Address - Country:US
Practice Address - Phone:617-928-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Multi-Specialty