Organization
LIPOLASER OF SOUTH JERSEY PC
Active
Other names
Revive Life Treatment Center of South Jersey
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY PISTONE MD (OWNER)
(856) 983-3600
Entity
Organization
Contact information
Practice address
100 CENTRE BLVD STE 100E, MARLTON, NJ 08053-4128
(856) 983-3600
Mailing address
100 CENTRE BLVD STE 100E, MARLTON, NJ 08053-4128
(856) 983-3600
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/30/2020
Last updated
09/30/2020
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