# HEALTH REVIVAL MEDICAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093742900
- **Authorized official:** LARISA VEKSMAN MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (718) 891-8822

## Contact information

- **Practice address:** HEALTH REVIVAL MEDICAL PC, 162 BRIGHTON STREET, BROOKLYN, NY 11235-5237
- **Practice address phone:** (718) 891-8822
- **Practice address fax:** (718) 891-8823
- **Mailing address:** 21 GOODAL STREET, BROOKLYN, NY 10308-3325
- **Mailing address phone:** (718) 891-8822
- **Mailing address fax:** (718) 891-8823

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 223381 | NY | Yes |

## Other

- **Enumeration date:** 06/27/2006
- **Last updated:** 08/22/2020