Provider Demographics
NPI:1205153251
Name:TRANSFORMATIONS PHYSICIANS WEIGHT MANAGEMENT LLC
Entity type:Organization
Organization Name:TRANSFORMATIONS PHYSICIANS WEIGHT MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-281-6771
Mailing Address - Street 1:719 HIGHWAY 206
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1536
Mailing Address - Country:US
Mailing Address - Phone:908-281-6771
Mailing Address - Fax:908-281-6439
Practice Address - Street 1:719 HIGHWAY 206
Practice Address - Street 2:SUITE 101
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1536
Practice Address - Country:US
Practice Address - Phone:908-281-6771
Practice Address - Fax:908-281-6439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09992000363LF0000X
NJMA067366207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ016208OtherMEDICARE, TYPE UNSPECIFIED