Organization · NPI-2

A Progressive Longevity Center,llc

Internal Medicine · Jersey City, NJ

NPI number1568515500
StatusActive
Last updated in NPPESMar 25, 2009

Details

NPI
1568515500
Entity type
Organization (NPI-2)
Legal business name
A Progressive Longevity Center,llc
Organization subpart
No
Enumeration date
Jan 21, 2007
Last updated
Mar 25, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal MedicineMA06826400NJYes

Practice location

2555 John F Kennedy Blvd
D
Jersey City, NJ 07304-2165

Phone 201-761-0717 · Fax 201-761-0787

Mailing address

100 Winston Dr
5 Hs
Cliffside Park, NJ 07010-3240

Phone 201-761-0717 · Fax 201-761-0787

Authorized official

Adelia Moustiatse
Owner
2017610717

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Internal Medicine providers in Jersey City, NJ