Healthcare Provider Details

I. General information

NPI: 1578474581
Provider Name (Legal Business Name): LONGEVITY HEALTH SERVICES NJ PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 WILLOUGHBY AVE
BROOKLYN NY
11205-4590
US

IV. Provider business mailing address

407 WILLOUGHBY AVE
BROOKLYN NY
11205-4590
US

V. Phone/Fax

Practice location:
  • Phone: 212-201-1252
  • Fax:
Mailing address:
  • Phone: 212-201-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL WERTZBERGER
Title or Position: CEO
Credential: MD
Phone: 212-201-1252