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General NPI Number Information
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NPI Number | 1477146058
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Entity Type | Organization
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Legal Business Name | LONGEVITY WELLNESS PA
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 251 ROCHELLE AVE
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3914
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Country | US
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Telephone | 201-291-1616
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Fax | 201-291-1619
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Provider Business Mailing Address
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Address Line | 201 W PASSAIC ST STE 301
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3126
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Country | US
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Telephone | 201-291-1616
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Fax | 201-291-1619
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN J CONTE
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Credential | DO
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Telephone | 201-291-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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