Organization
LONGEVITY MEDICAL GROUP, P.A.
Active
Other names
Longevity Medical Group, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER HOWARD COLETTI MD (PRESIDENT)
(201) 265-4647
Entity
Organization
Contact information
Practice address
2 SEARS DR, PARAMUS, NJ 07652-3539
(201) 265-4647
Mailing address
PO BOX 8069, PARAMUS, NJ 07653-8069
(201) 265-4647
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA42243
NJ
Other
Enumeration date
02/02/2010
Last updated
02/02/2010
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