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Contact Information

ACTIVELIFE REGENERATIVE THERAPIES
413 WANAQUE AVE
POMPTON LAKES, NJ07442-1844
 Phone: 973-997-0542
 Fax: 973-831-6763
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for ACTIVELIFE REGENERATIVE THERAPIES

NPI Number 1225708886
LBN Legal business name ACTIVELIFE REGENERATIVE THERAPIES
Authorized official KENNETH WOLOSZ - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/15/2021
Last updated 01/05/2022 - About 4 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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