Provider Demographics
NPI:1851679831
Name:WESTCHESTER WEIGHT LOSS & WELLNESS LLC
Entity Type:Organization
Organization Name:WESTCHESTER WEIGHT LOSS & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDN
Authorized Official - Phone:914-984-5533
Mailing Address - Street 1:8 ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-1510
Mailing Address - Country:US
Mailing Address - Phone:914-984-5533
Mailing Address - Fax:
Practice Address - Street 1:8 ROCKLEDGE RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-1510
Practice Address - Country:US
Practice Address - Phone:914-984-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty