NPIMap

Organization Active NPI

Optimal Wellness of West Hartford,LLC

  • Obesity Medicine (Family Medicine) Physician
  • West Hartford, CT
National Provider Identifier
1497127260
Registry record updated Oct 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Family Medicine) PhysicianTaxonomy code 207QB0002X
License
207Q00000X Issued in CT
Legal business name
OPTIMAL WELLNESS OF WEST HARTFORD,LLC
Practice address
1001 Farmington Ave
West Hartford, CT 06107-2135
Phone
(860) 213-8365
NPI assigned
Oct 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Luiza F Petre, M.D.
Title
Owner
Phone
(212) 553-2700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QB0002X 207Q00000X CT Primary
Obesity Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RB0002X 207R00000X

Addresses

Primary practice location

1001 Farmington Ave
West Hartford, CT 06107-2135

Mailing address

1001 Farmington Ave
West Hartford, CT 06107-2135
Phone (860) 213-8365

Other names 1

  • Medi-Weightloss Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medi-Weightloss2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445299200000",
    "number": "1497127260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 FARMINGTON AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072135",
            "telephone_number": "860-213-8365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 FARMINGTON AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072135",
            "telephone_number": "860-213-8365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL WELLNESS OF WEST HARTFORD,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-20",
        "last_updated": "2015-10-20",
        "status": "A",
        "authorized_official_last_name": "PETRE",
        "authorized_official_first_name": "LUIZA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-553-2700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "CT",
            "license": "207Q00000X",
            "primary": true
        },
        {
            "code": "207RB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": null,
            "license": "207R00000X",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medi-Weightloss Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.