# REVIVE SPINE AND PAIN CENTER

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

## Provider details

- **NPI number:** 1235674912
- **Authorized official:** MIKE NAMMOUR (MANAGER)
- **Authorized official phone:** (856) 983-9001

## Contact information

- **Practice address:** 1001 LINCOLN DR W STE E, MARLTON, NJ 08053-1534
- **Practice address phone:** (856) 983-9001
- **Practice address fax:** (856) 983-9011
- **Mailing address:** PO BOX 1126, ABSECON, NJ 08201-5126
- **Mailing address phone:** (856) 983-9001
- **Mailing address fax:** (856) 983-9011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/04/2017
- **Last updated:** 01/31/2024