Provider Demographics
NPI:1912450008
Name:LIVINGSTON 1 WEIGHTLOSS, LLC
Entity Type:Organization
Organization Name:LIVINGSTON 1 WEIGHTLOSS, LLC
Other - Org Name:MEDI WEIGHTLOSS LIVINGSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF INSURANCE DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NONCLERC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-228-6334
Mailing Address - Street 1:5 REGENT ST
Mailing Address - Street 2:SUITE 509
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1675
Mailing Address - Country:US
Mailing Address - Phone:973-251-2437
Mailing Address - Fax:973-251-2654
Practice Address - Street 1:5 REGENT ST
Practice Address - Street 2:SUITE 509
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1675
Practice Address - Country:US
Practice Address - Phone:973-251-2437
Practice Address - Fax:973-251-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty