Organization
A PROGRESSIVE LONGEVITY CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADELIA MOUSTIATSE M.D. (OWNER)
(201) 761-0717
Entity
Organization
Contact information
Practice address
2555 JOHN F KENNEDY BLVD, D, JERSEY CITY, NJ 07304-2165
(201) 761-0717
(201) 761-0787
Mailing address
100 WINSTON DR, 5 HS, CLIFFSIDE PARK, NJ 07010-3240
(201) 761-0717
(201) 761-0787
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MA06826400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7866305
—
NJ
Enumeration date
01/21/2007
Last updated
03/25/2009
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