Provider Demographics
NPI:1972782696
Name:GRAND PROFESSIONAL WEIGHT CONTROL
Entity Type:Organization
Organization Name:GRAND PROFESSIONAL WEIGHT CONTROL
Other - Org Name:ALLAN LAZAR MD & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-568-3742
Mailing Address - Street 1:420 GRAND AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-568-3742
Mailing Address - Fax:201-836-3178
Practice Address - Street 1:420 GRAND AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-568-3742
Practice Address - Fax:201-836-3178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA20014207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527855Medicare PIN