NPIMap

Organization Active NPI

Active Health Marmora LLC

Doing business as Active Joint and Spine Institute

  • Family Medicine Physician
  • Marmora, NJ
National Provider Identifier
1629707369
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ACTIVE HEALTH MARMORA LLC
Doing business as
Active Joint and Spine Institute
Practice address
16 Roosevelt Blvd
Marmora, NJ 08223-2032
Phone
(609) 886-8585
NPI assigned
Jun 8, 2022
Last updated
Jun 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Authorized official

Name
Robert OlivieriNPI 1043224090
Title
Authorized Official
Phone
(609) 886-8585

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

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 1

  • ACTIVE JOINT AND SPINE INSTITUTE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Locations

16 Roosevelt Blvd
Marmora, NJ 08223
Phone (609) 272-0909

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654646400000",
    "number": "1629707369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 ROUTE 47",
            "city": "RIO GRANDE",
            "state": "NJ",
            "postal_code": "082421401",
            "telephone_number": "609-886-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 ROOSEVELT BLVD",
            "city": "MARMORA",
            "state": "NJ",
            "postal_code": "082232032",
            "telephone_number": "609-886-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE HEALTH MARMORA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A",
        "authorized_official_last_name": "OLIVIERI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "609-886-8585"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ACTIVE JOINT AND SPINE INSTITUTE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marmora, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; 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.