# ACTIVE AGING MEDICAL GROUP INC

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

## Provider details

- **NPI number:** 1720368772
- **Authorized official:** ALEXANDER KOLESSA M.D. (CHIEF MEDICAL OFFICER)
- **Authorized official phone:** (732) 425-3564

## Contact information

- **Practice address:** 188 JEFFERSON ST, SUITE\# 111, NEWARK, NJ 07105-1622
- **Practice address phone:** (732) 425-3564
- **Practice address fax:** (212) 238-7760
- **Mailing address:** 188 JEFFERSON ST, SUITE\# 111, NEWARK, NJ 07105-1622
- **Mailing address phone:** (732) 425-3564
- **Mailing address fax:** (212) 238-7760

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/23/2011
- **Last updated:** 08/23/2011