Organization
WEIGHT LOSS INSTITUTE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE DACOSTA A MD (MD)
(973) 674-8866
Entity
Organization
Contact information
Practice address
268 MARTIN LUTHER KING JR BLVD, NEWARK, NJ 07102-2011
(973) 674-8866
Mailing address
22 CHESTNUT ST, LIVINGSTON, NJ 07039-5502
(973) 674-8866
(973) 672-9299
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA05600200
NJ
174400000X
Specialist
25MA07916100
NJ
Other
Enumeration date
01/21/2011
Last updated
01/21/2011
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