# REVIVE BY CAROLINA, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jersey Hydreigth
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194404574
- **Authorized official:** MRS. SANDRES MARTINEZ (MANAGER)
- **Authorized official phone:** (201) 916-9544

## Contact information

- **Practice address:** 1086 TEANECK RD STE 4F1, TEANECK, NJ 07666-4857
- **Practice address phone:** (201) 916-9544
- **Mailing address:** 1086 TEANECK RD STE 4F1, TEANECK, NJ 07666-4857
- **Mailing address phone:** (201) 916-9544

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | — | NULL | Yes |
| 207RI0200X | Infectious Disease Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/13/2023
- **Last updated:** 09/19/2024