Weight Loss Institute Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA05600200 Issued in NJ

Legal business name

WEIGHT LOSS INSTITUTE INC

Practice address

268 Martin Luther King Jr Blvd
Newark, NJ 07102-2011

Phone

(973) 674-8866

NPI assigned

Jan 21, 2011

Last updated

Jan 21, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Theodore Dacosta A, MD

Title

MD

Phone

(973) 674-8866

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295568000000",
    "number": "1891090858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 CHESTNUT ST",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395502",
            "telephone_number": "973-674-8866",
            "fax_number": "973-672-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "268 MARTIN LUTHER KING JR BLVD",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071022011",
            "telephone_number": "973-674-8866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEIGHT LOSS INSTITUTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-21",
        "last_updated": "2011-01-21",
        "status": "A",
        "authorized_official_last_name": "A",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "DACOSTA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "973-674-8866",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA05600200",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA07916100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Newark, NJ
• Providers in Newark, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; 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.