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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: October 18, 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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lyceum Longevity Center Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

7

Medicare enrollment records show 7 clinicians reassign Medicare billing to Lyceum Longevity Center PLLC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (7)

William Pezzello, D.C.
Chiropractic
NPI 1720278740
445 LYCEUM AVE
Philadelphia, PA 19128
(215) 508-5555
✔ PECOS0.1 mi
Matthew Cahill, MD
Internal Medicine
NPI 1528031325
825 OLD LANCASTER RD SUITE 320
Bryn Mawr, PA 19010
(610) 527-3800
✔ PECOS5.7 mi
Paul Ezeukwu, MSPT
Physical Therapist in Private Practice
NPI 1326175936
2701 SOUTHAMPTON RD
Philadelphia, PA 19154
(215) 965-0326
13 mi
Geenander Raju, DNP, CRNP, FNP-BC
Nurse Practitioner
NPI 1356823959
106 S FRALEY ST
Kane, PA 16735
(215) 858-3357
✔ PECOS219 mi
Patricia Woods, M.D.
Hospitalist
NPI 1760614655
320 E NORTH AVE
Pittsburgh, PA 15212
(412) 359-3030
✔ PECOS✔ Accepts Medicare253 mi
Panya Henry
Nurse Practitioner
NPI 1124681507
4838 NEWPORT CT N/A
Nashville, NC 27856
(215) 290-6428
✔ PECOS✔ Accepts Medicare314 mi
Samuel Schepart
Chiropractic
NPI 1528536901
2029 OSPREY LN STE B
Lutz, FL 33549
(813) 254-2500
✔ Accepts Medicare915 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

Is Lyceum Longevity Center PLLC enrolled in Medicare?

Yes. Lyceum Longevity Center PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lyceum Longevity Center PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians reassign their Medicare billing to Lyceum Longevity Center PLLC, in Chiropractic, Hospitalist, Internal Medicine, Nurse Practitioner and Physical Therapist in Private Practice. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.