Organization
REVIVIFY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCO DIMAYORCA PARAMEDIC (MANAGING MEMBER)
(908) 273-2222
Entity
Organization
Contact information
Practice address
68 RIVER ROAD, ANNEX, SUMMIT, NJ 07901-1450
(908) 273-2222
Mailing address
68 RIVER ROAD, ANNEX, SUMMIT, NJ 07901-1450
(908) 273-2222
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Enumeration date
12/20/2021
Last updated
12/20/2021
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