Provider Demographics
NPI:1942480132
Name:NUTRITION AND WEIGHT MANAGEMENT CENTER OF FAIRFIELD COUNTY, LLC
Entity Type:Organization
Organization Name:NUTRITION AND WEIGHT MANAGEMENT CENTER OF FAIRFIELD COUNTY, LLC
Other - Org Name:NWMC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INDU
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-692-2180
Mailing Address - Street 1:115 TECHNOLOGY DR
Mailing Address - Street 2:STE B-106
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6337
Mailing Address - Country:US
Mailing Address - Phone:203-692-2180
Mailing Address - Fax:203-452-1412
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:STE B-106
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6337
Practice Address - Country:US
Practice Address - Phone:203-692-2180
Practice Address - Fax:203-452-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000380133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty