OrganizationActive
A Progressive Longevity Center,llc
NPI 1568515500 · Internal Medicine Physician · Jersey City, NJ
Provider details
- NPI number
- 1568515500
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Adelia Moustiatse, Owner(201) 761-0717
- License
- MA06826400 (NJ)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
2555 John F Kennedy Blvd
D
Jersey City, NJ 07304-2165
Phone: (201) 761-0717
Fax: (201) 761-0787
Approximate (ZIP-level) locationGet directions
Mailing address
100 Winston Dr
Cliffside Park, NJ 07010-3240
Registry dates
- Enumerated
- 2007-01-21
- Last updated
- 2009-03-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.