1497577837 NPI number — CENTER FOR DIABETES AND WELLNESS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497577837 NPI number — CENTER FOR DIABETES AND WELLNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR DIABETES AND WELLNESS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497577837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 PALMETTO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70065-6826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-716-4428
Provider Business Mailing Address Fax Number:
985-781-4319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3212 S 110 SERVICE RD W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70001-7006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-766-9758
Provider Business Practice Location Address Fax Number:
985-781-4319
Provider Enumeration Date:
10/28/2024

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
ABDUL
Authorized Official Middle Name:
MANNAH
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
504-766-9758

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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