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LYCEUM LONGEVITY CENTER PLLC
NPI 1831666585
Specialist in Philadelphia, PA

Active since October 31, 2018
6062 RIDGE AVE, PHILADELPHIA, PA 19128(215) 508-5555(215) 508-5555 Get Directions Write a Review

NPPES record last updated: October 4, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Oct 4, 2019, May 6, 2019, Oct 31, 2018 (3 updates tracked since 2018).

About Lyceum Longevity Center Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LYCEUM LONGEVITY CENTER PLLC (NPI 1831666585) is a healthcare organization registered as a specialist in Philadelphia, Pennsylvania and active in the NPI registry since October 2018. The organization lists William J Pezzello, Co-founder, as its authorized official.

NPPES Registry Identity

NPI1831666585
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameLYCEUM LONGEVITY CENTER PLLC
Location Address6062 RIDGE AVEPhiladelphia, PA 19128-1647
Mailing Address6062 Ridge AvePhiladelphia, PA 19128-1647 · (215) 508-5555 · Fax (215) 508-5555
Phone(215) 508-5555
Fax(215) 508-5555
Organization SubpartNo
Authorized OfficialWilliam J PezzelloCo-founder · (215) 508-5555
Enumeration DateOctober 31, 2018
Last NPPES UpdateOctober 4, 20193 updates tracked since enumeration
✔ NPI 1831666585 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Also ListedChiropractorTaxonomy 111N00000X
Also ListedRadiology · Diagnostic RadiologyTaxonomy 2085R0202X
6062 RIDGE AVE, Philadelphia, PA 19128
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHERINE MELCHIONNI PA-C
Physician Assistant
6062 RIDGE AVE
PHILADELPHIA, PA 19128
Philadelphia County (215) 395-7546
AMULYA PONNA
Physician Assistant
6062 RIDGE AVE
PHILADELPHIA, PA 19128
Philadelphia County (212) 385-3700
VIVIAN WAN-WAI LO PA-C
Physician Assistant
6062 RIDGE AVE
PHILADELPHIA, PA 19128
Philadelphia County (215) 395-7546

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lyceum Longevity Center PLLC's NPI number?

The NPI number for Lyceum Longevity Center PLLC is 1831666585. It was assigned to this organization in the NPPES registry on October 31, 2018.

Where is Lyceum Longevity Center PLLC located?

Lyceum Longevity Center PLLC is located at 6062 Ridge Ave, Philadelphia, PA 19128. The listed phone number is (215) 508-5555.

What is Lyceum Longevity Center PLLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Lyceum Longevity Center PLLC was last updated on October 4, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.