Organization
LONGEVITY MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEWIS KORB D.C. (PRESIDENT)
(732) 721-6789
Entity
Organization
Contact information
Practice address
540 BORDENTOWN AVENUE, SUITE 4200, SOUTH AMBOY, NJ 08879-0157
(732) 721-6789
Mailing address
540 BORDENTOWN AVENUE, SUITE 4200, SOUTH AMBOY, NJ 08879-0157
(732) 721-6789
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
25MA03609800
NJ
174400000X
Specialist
26NR12059400
NJ
174400000X
Specialist
Primary
38MC00433200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
088771
MEDICARE IDENTIFICATION NUMBER
NJ
Enumeration date
05/05/2008
Last updated
05/05/2008
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