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Organization
REVIVE SPINE AND PAIN CENTER
Active
Organization
REVIVE SPINE AND PAIN CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL RIZKALLA MD (DIRECTOR)
(856) 983-9001
Entity
Organization
Contact information
Practice address
1001 LINCOLN DR W STE E, MARLTON, NJ 08053-1534
(856) 983-9001
(856) 983-9011
Mailing address
PO BOX 1126, ABSECON, NJ 08201
(856) 983-9001
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
261QP3300X
Pain Clinic/Center
25MA08922900
NJ
Other
Enumeration date
01/05/2017
Last updated
01/31/2024
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