# MEDICAL WEIGHT LOSS OF NEW YORK, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174940696
- **Authorized official:** BRYAN T WENDEL (PRACTICE MANAGER)
- **Authorized official phone:** (315) 445-0003

## Contact information

- **Practice address:** 6800 E GENESEE ST, SUITE 1501, FAYETTEVILLE, NY 13066-1089
- **Practice address phone:** (315) 391-9390
- **Practice address fax:** (315) 445-0056
- **Mailing address:** 6800 E GENESEE ST, SUITE 1501, FAYETTEVILLE, NY 13066-1089
- **Mailing address phone:** (315) 391-9390
- **Mailing address fax:** (315) 445-0056

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | — | Yes |
| 207RB0002X | Obesity Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RB0002X | Obesity Medicine (Internal Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 03/21/2014
- **Last updated:** 03/21/2014