Provider Demographics
NPI:1386354579
Name:NU AGE MEDICINE, LLC
Entity type:Organization
Organization Name:NU AGE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:AMICI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-918-0537
Mailing Address - Street 1:632 MONTGOMERY AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2000
Mailing Address - Country:US
Mailing Address - Phone:267-603-3140
Mailing Address - Fax:
Practice Address - Street 1:632 MONTGOMERY AVE FL 3
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2000
Practice Address - Country:US
Practice Address - Phone:267-603-3140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty