Active Aging Medical P.C.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

254294 Issued in NY

Legal business name

ACTIVE AGING MEDICAL P.C.

Practice address

244 5TH Ave
Suite 200
New York, NY 10001-7604

Phone

(732) 425-3564

Fax

(888) 999-8689

NPI assigned

Nov 19, 2014

Last updated

Jan 21, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alexander Kolessa, MDNPI 1902009459

Title

President

Phone

(732) 425-3564

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alexander Kolessa, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • New York, NY
  • NPI 1902009459
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421798400000",
    "number": "1073910055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 5TH AVE",
            "address_2": "SUITE 200",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100017604",
            "telephone_number": "732-425-3564",
            "fax_number": "888-999-8689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 5TH AVE",
            "address_2": "SUITE 200",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100017604",
            "telephone_number": "732-425-3564",
            "fax_number": "888-999-8689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE AGING MEDICAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-19",
        "last_updated": "2015-01-21",
        "status": "A",
        "authorized_official_last_name": "KOLESSA",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-425-3564",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "254294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in New York, NY
• Providers in New York, NY by specialty
• Geriatric Medicine (Internal Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.