Active Aging Medical Group Inc

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

ACTIVE AGING MEDICAL GROUP INC

Practice address

188 Jefferson St
Suite# 111
Newark, NJ 07105-1622

Phone

(732) 425-3564

Fax

(212) 238-7760

NPI assigned

Aug 23, 2011

Last updated

Aug 23, 2011By 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, M.D.NPI 1902009459

Title

Chief Medical Officer

Phone

(732) 425-3564

Specialties & licenses 1

Addresses

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
  NPD (past) Authorized official

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

{
    "created_epoch": "1314057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314057600000",
    "number": "1720368772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 JEFFERSON ST",
            "address_2": "SUITE# 111",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071051622",
            "telephone_number": "732-425-3564",
            "fax_number": "212-238-7760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 JEFFERSON ST",
            "address_2": "SUITE# 111",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071051622",
            "telephone_number": "732-425-3564",
            "fax_number": "212-238-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE AGING MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-23",
        "last_updated": "2011-08-23",
        "status": "A",
        "authorized_official_last_name": "KOLESSA",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "732-425-3564",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Indira Acosta
• Merylyn Acosta, DPT
• Loretta Acquaah
• Constance Acquah
• John Acquaviva, DO
• Acupuncture Healthcare Plaza III
• Shawn Adam, MD
• Raylor Adames
• Ineshia Adams
• Karen Jeannine Adams, LSW

• Medical Specialty Clinic/Center in Newark, NJ
• Providers in Newark, NJ by specialty
• Medical Specialty Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.