NPIMap

Organization Active NPI

Longevity Medical LLC

  • Specialist
  • South Amboy, NJ
National Provider Identifier
1972779486
Registry record updated May 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
38MC00433200 Issued in NJ
Legal business name
LONGEVITY MEDICAL LLC
Practice address
540 Bordentown Avenue
Suite 4200
South Amboy, NJ 08879-0157
Phone
(732) 721-6789
NPI assigned
May 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2008

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

Authorized official

Name
Lewis Korb, D.C.NPI 1760553051
Title
President
Phone
(732) 721-6789

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 38MC00433200 NJ Primary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 25MA03609800 NJ
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 26NR12059400 NJ

Addresses

Primary practice location

540 Bordentown Avenue
Suite 4200
South Amboy, NJ 08879-0157

Mailing address

540 Bordentown Avenue
Suite 4200
South Amboy, NJ 08879-0157
Phone (732) 721-6789

Other identifiers 1

IdentifierTypeStateIssuer
088771OtherNJMEDICARE IDENTIFICATION NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1972779486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 BORDENTOWN AVENUE",
            "address_2": "SUITE 4200",
            "city": "SOUTH AMBOY",
            "state": "NJ",
            "postal_code": "088790157",
            "telephone_number": "732-721-6789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 BORDENTOWN AVENUE",
            "address_2": "SUITE 4200",
            "city": "SOUTH AMBOY",
            "state": "NJ",
            "postal_code": "088790157",
            "telephone_number": "732-721-6789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-05",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "KORB",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-721-6789",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "38MC00433200",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA03609800",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "26NR12059400",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IDENTIFICATION NUMBER",
            "identifier": "088771",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Amboy, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; 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.