Organization
REVIVE HEALTH AND AESTHETICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADEKUNLE A. FAJANA MD (PRESIDENT)
(508) 735-3280
Entity
Organization
Contact information
Practice address
294 N MAIN ST, EAST LONGMEADOW, MA 01028-1838
(413) 224-1009
Mailing address
294 N MAIN ST, EAST LONGMEADOW, MA 01028-1838
(413) 224-1009
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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