Provider Demographics
NPI:1952992455
Name:ACT ON TOTAL HEALTH MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:ACT ON TOTAL HEALTH MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:REGIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:096-272-0655
Mailing Address - Street 1:8025 BLACK HORSE PIKE STE 501
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2967
Mailing Address - Country:US
Mailing Address - Phone:609-822-7979
Mailing Address - Fax:609-822-7980
Practice Address - Street 1:1634 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1108
Practice Address - Country:US
Practice Address - Phone:609-822-7979
Practice Address - Fax:609-822-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty