| NPI | 1811229875 |
|---|---|
| Former Legal Business Name | LONGEVITY MEDICAL GROUP, P.A. |
| Entity Type | Organization |
| Authorized Contact | ROGER HOWARD COLETTI President 201-265-4647 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ MA42243) |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2010-02-02 |