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General NPI Number Information
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NPI Number | 1952992455
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Entity Type | Organization
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Legal Business Name | ACT ON TOTAL HEALTH MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 01/28/2021
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 1634 NEW RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1108
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Country | US
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Telephone | 609-822-7979
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Fax | 609-822-7980
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Provider Business Mailing Address
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Address Line | 8025 BLACK HORSE PIKE STE 501
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City | PLEASANTVILLE
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State | NJ
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Zip | 08232-2967
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Country | US
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Telephone | 609-822-7979
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Fax | 609-822-7980
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Authorized Official
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Title or Position | CEO/OWNER
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Name | JON REGIS
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Credential | MD
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Telephone | 96-272-0655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 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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