# THE LONGEVITY LAB LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174311765
- **Authorized official:** DR. MOHAMMAD JARBOU MD (CO-OWNER)
- **Authorized official phone:** (573) 639-0292

## Contact information

- **Practice address:** 100 S KEENE ST, COLUMBIA, MO 65201-6603
- **Practice address phone:** (573) 968-6822
- **Mailing address:** 100 S KEENE ST, COLUMBIA, MO 65201-6603
- **Mailing address phone:** (573) 968-6822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/25/2025
- **Last updated:** 04/25/2025