Active Health Marmora LLC
Organization Active NPI Family Medicine Physician · Marmora, NJ
NPI 1629707369 · NPPES record last updated Jun 8, 2022
Key facts
- NPI
- 1629707369
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ACTIVE HEALTH MARMORA LLC
- Practice address
- 16 Roosevelt Blvd
Marmora, NJ 08223-2032 - Phone
- (609) 886-8585
- NPI assigned
- Jun 8, 2022
- Organization subpart
- No
Authorized official
- Name
- Robert Olivieri
- Title
- Authorized Official
- Phone
- (609) 886-8585
Practitioners 17
-
Arianna Aaron, DC
-
Shakira Alexander, CRNP
-
Adam Ross Gillman, D.C.
-
Robert Kovarik, DC
-
Denay L Marino, D.O.
-
Michael Nammour, DC
-
Alexander Scott Paluzzi, OTR-L
-
Brian Joseph Portanova, FNP-BC
-
Andrea Diane Phillips, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240111004280 | NJ | Part B Supplier - Clinic/Group Practice | 2961853122 |
Receives reassigned benefits from 16 practitioners Practice locations: Marmora, NJ |
| O20250612000819 | NJ | DME Supplier - Multi-Specialty - Physician | 2961853122 | Practice locations: Marmora, NJ |
National Provider Directory
Locations
16 Roosevelt Blvd
Marmora, NJ 08223
Phone (609) 272-0909
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | |||
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
16 Roosevelt Blvd
Marmora, NJ 08223-2032
Mailing address
1501 Route 47
Rio Grande, NJ 08242-1401
Phone (609) 886-8585
Other names
- ACTIVE JOINT AND SPINE INSTITUTE
Other providers in Marmora, NJ
- 4Crippens LLC
- Beth Anne Addis
- Kaleem Ahmad
- Anchored Adolescent & Child Psychiatry LLC
- Atlanitcare Physician Group
- Atlanticare Physician Group PA
All providers in Marmora, NJ · Family Medicine Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.