Organization
ACTIVE AGING MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER KOLESSA M.D. (CHIEF MEDICAL OFFICER)
(732) 425-3564
Entity
Organization
Contact information
Practice address
188 JEFFERSON ST, SUITE# 111, NEWARK, NJ 07105-1622
(732) 425-3564
(212) 238-7760
Mailing address
188 JEFFERSON ST, SUITE# 111, NEWARK, NJ 07105-1622
(732) 425-3564
(212) 238-7760
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/23/2011
Last updated
08/23/2011
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