# A PROGRESSIVE LONGEVITY CENTER,LLC

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

## Provider details

- **NPI number:** 1568515500
- **Authorized official:** DR. ADELIA MOUSTIATSE M.D. (OWNER)
- **Authorized official phone:** (201) 761-0717

## Contact information

- **Practice address:** 2555 JOHN F KENNEDY BLVD, D, JERSEY CITY, NJ 07304-2165
- **Practice address phone:** (201) 761-0717
- **Practice address fax:** (201) 761-0787
- **Mailing address:** 100 WINSTON DR, 5 HS, CLIFFSIDE PARK, NJ 07010-3240
- **Mailing address phone:** (201) 761-0717
- **Mailing address fax:** (201) 761-0787

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MA06826400 | NJ | Yes |

## Other

- **Enumeration date:** 01/21/2007
- **Last updated:** 03/25/2009