Provider Demographics
NPI:1154930220
Name:JERSEY SURGICAL WEIGHT CONTROL CENTER LLC
Entity type:Organization
Organization Name:JERSEY SURGICAL WEIGHT CONTROL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LILIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROKURAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-304-3436
Mailing Address - Street 1:222 SCHANCK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2974
Mailing Address - Country:US
Mailing Address - Phone:800-920-9928
Mailing Address - Fax:800-615-9936
Practice Address - Street 1:222 SCHANCK RD STE 200
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2974
Practice Address - Country:US
Practice Address - Phone:800-920-9928
Practice Address - Fax:800-615-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty