LONGEVITY MEDICAL GROUP, P.A. (NPI# 1811229875) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811229875 |
| Entity Type | Organization |
| Organization Name | LONGEVITY MEDICAL GROUP, P.A. |
| Other Organization Name | LONGEVITY MEDICAL GROUP, P.A. |
| Practice Address |
2 Sears Dr Paramus NJ 07652-3539 |
| Mailing Address |
Po Box 8069 Paramus NJ 07653-8069 |
| Practice Telephone | 2012654647 |
| Mailing Telephone | 2012654647 |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2010-02-02 |
| Authorized Official Name | DR. ROGER HOWARD COLETTI (PRESIDENT) |
| Authorized Official Telephone | 2012654647 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | MA42243 | NJ | Other Service Providers |
| Other Name | Type Code |
|---|---|
| Longevity Medical Group, P.A. | Former Legal Business Name - Organization |
| Street Address |
2 SEARS DR |
| City | PARAMUS |
| State | NJ |
| Zip Code | 07652-3539 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053398602 | Theodore P Sgambati | Internal Medicine | 2 Sears Dr, Floor 2, Paramus, NJ 07652-3539 | 2005-12-26 |
| 1780220764 | One Oak Medical Group, LLC | Specialist | 2 Sears Dr, Paramus, NJ 07652 | 2019-11-25 |
| 1881805711 | Bergen Medical Imaging, LLC | Clinic/Center | 2 Sears Dr, Paramus, NJ 07652-3539 | 2007-05-24 |
| 1497966352 | North American Diagnostic Imaging, LLC | Contractor | 2 Sears Dr, 2nd Floor, Paramus, NJ 07652-3539 | 2007-05-24 |
| 1952334542 | Joseph G Wiedermann | Internal Medicine | 2 Sears Dr, Paramus, NJ 07652-3539 | 2006-07-08 |
| 1124071261 | John Asghar Chuback | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2 Sears Dr, Suite 101, Paramus, NJ 07652-3539 | 2006-05-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750997789 | Eunice Ramos | Nurse Practitioner | 300-a Forest Avenue, Paramus, NJ 07652 | 2020-09-15 |
| 1740801679 | Daniel Khodorkovsky | Dentist | 1615 Paramus Park, Paramus, NJ 07652 | 2020-05-01 |
| 1548806177 | Shira R Goldstein | Social Worker | 10 Valley Health Plaza, Paramus, NJ 07652 | 2019-11-19 |
| 1225598634 | Life Opportunities Unlimited A Non-profit Corp. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 157 Windsor Rd, Paramus, NJ 07652 | 2019-03-21 |
| 1639635766 | Inna Revutsky | Acupuncturist | Applied Kinesiology Center of Nj, 1 Sears Drive Suite 203, Paramus, NJ 07652 | 2019-02-13 |
| 1154899532 | Aleksandra Bozovic | Nurse Practitioner | 970 Linwood Avenue, Suite 102, Paramus, NJ 07652 | 2018-11-05 |
| 1689156044 | Christopher John Kailath | Behavioral Analyst | 10 Forest Ave Suite 214, Paramus, NJ 07652 | 2018-09-02 |
| 1841786696 | Molly Katherine Lenny | Optometrist | 501 Route 17 South, Paramus, NJ 07652 | 2018-07-05 |
| 1508356155 | Physical Therapy Now Holdings Nj LLC | Clinic/Center | 695 Route 17 South, Paramus, NJ 07652 | 2018-05-18 |
| 1821514373 | Simona Dlabal | Nurse Practitioner | 69 Prospect St, Paramus, NJ 07652 | 2017-08-16 |
| Find all providers in zip 07652 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588070874 | Roel P Galope Do | Specialist | 186 N Farview Ave, Paramus, NJ 07652-3235 | 2014-07-07 |
| 1821350133 | Maria Elizabeth Salyer | Specialist | 519 Green Valley Rd, Paramus, NJ 07652-1810 | 2012-06-12 |
| 1417090697 | Tom R Willemann | Specialist | 1 E Ridgewood Ave, Paramus, NJ 07652-3629 | 2007-02-15 |
| 1669511036 | Syed A Rasheed | Specialist | 12 N State Rt 17, Suite 313, Paramus, NJ 07652-2644 | 2007-02-05 |
| 1093864563 | Solomon Halioua | Specialist | 22 Madison Ave Ste 201, Paramus, NJ 07652-2721 | 2007-01-10 |
| 1386701282 | Amit Trivedi | Specialist | 81 Rte. 4 W., 35 Plaza Professional Center, Suite 401, Paramus, NJ 07652-0058 | 2007-01-02 |
| 1841353737 | Advanced Laparoscopic Associates | Specialist | 81rte. 4w., 35 Plaza Professional Center, Suite 401, Paramus, NJ 07652-0058 | 2006-12-19 |
| 1851405781 | Spine & Sports Rehab Ctr | Specialist | 205 Robin Rd Ste 118, Paramus, NJ 07652-1424 | 2006-08-18 |
| 1063400547 | Donna Nickles | Specialist | 80 Eisenhower Dr, Suite 200, Paramus, NJ 07652-1401 | 2005-10-10 |
| 1134113582 | Heripsime Ohanian | Specialist | 1 Kalisa Way, Suite 103, Paramus, NJ 07652-3516 | 2005-08-31 |
| Find all providers in PARAMUS | ||||
Please comment or provide details below to improve the information on LONGEVITY MEDICAL GROUP, P.A..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.