# LIPOLASER OF SOUTH JERSEY PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revive Life Treatment Center of South Jersey
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205443405
- **Authorized official:** GREGORY PISTONE MD (OWNER)
- **Authorized official phone:** (856) 983-3600

## Contact information

- **Practice address:** 100 CENTRE BLVD STE 100E, MARLTON, NJ 08053-4128
- **Practice address phone:** (856) 983-3600
- **Mailing address:** 100 CENTRE BLVD STE 100E, MARLTON, NJ 08053-4128
- **Mailing address phone:** (856) 983-3600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/30/2020
- **Last updated:** 09/30/2020