| A Progressive Longevity Center,llc | |
|
2555 John F Kennedy Blvd D Jersey City NJ 07304-2165 | |
| (201) 761-0717 | |
| (201) 761-0787 |
| Full Name | A Progressive Longevity Center,llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2555 John F Kennedy Blvd, Jersey City, New Jersey |
| Authorized Official Name and Position | Adelia Moustiatse (OWNER) |
| Authorized Official Contact | 2017610717 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| A Progressive Longevity Center,llc 100 Winston Dr 5 Hs Cliffside Park NJ 07010-3240 Ph: (201) 761-0717 | A Progressive Longevity Center,llc 2555 John F Kennedy Blvd D Jersey City NJ 07304-2165 Ph: (201) 761-0717 |
| NPI Number | 1568515500 |
|---|---|
| Provider Enumeration Date | 01/21/2007 |
| Last Update Date | 03/25/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568515500 | NPI | - | NPPES |
| 7866305 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MA06826400 (New Jersey) | Primary |
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