Provider Demographics
NPI:1700588571
Name:NEW YOU SURGICAL WEIGHT LOSS, LLC
Entity Type:Organization
Organization Name:NEW YOU SURGICAL WEIGHT LOSS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-887-7605
Mailing Address - Street 1:456 N NEW BALLAS RD STE 386
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6846
Mailing Address - Country:US
Mailing Address - Phone:314-341-2327
Mailing Address - Fax:
Practice Address - Street 1:456 N NEW BALLAS RD STE 386
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6846
Practice Address - Country:US
Practice Address - Phone:314-887-7605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty