Provider Demographics
NPI:1356182430
Name:PRIME WEIGHT LOSS LLC
Entity type:Organization
Organization Name:PRIME WEIGHT LOSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATTAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-915-4211
Mailing Address - Street 1:2 INDEPENDENCE CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3001
Mailing Address - Country:US
Mailing Address - Phone:475-777-6912
Mailing Address - Fax:
Practice Address - Street 1:2 INDEPENDENCE CIR
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3001
Practice Address - Country:US
Practice Address - Phone:475-777-6912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty