Provider Demographics
NPI:1780004465
Name:METABOLIC WELLNESS AND LONGEVITY INSTITUTE LLC
Entity Type:Organization
Organization Name:METABOLIC WELLNESS AND LONGEVITY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-626-9200
Mailing Address - Street 1:266 KING GEORGE RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:266 KING GEORGE RD
Practice Address - Street 2:SUITE H
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5120
Practice Address - Country:US
Practice Address - Phone:908-626-9200
Practice Address - Fax:908-626-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty