Organization
REVIVE MEDICAL GROUP, P.C.
Active
Organization
REVIVE MEDICAL GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR ZIYADEH (PC MANAGER)
(203) 430-1321
Entity
Organization
Contact information
Practice address
1600 N 2ND ST, CLINTON, MO 64735-1192
(203) 430-1321
Mailing address
810 REEF RD, FAIRFIELD, CT 06824-6538
(203) 430-1321
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
04/07/2021
Last updated
04/13/2021
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