Organization
REVITAL RETREAT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN JAVIER APRN (ADVANCE PRACTICE NURSE/ OWNER)
(732) 589-9388
Entity
Organization
Contact information
Practice address
371 HOES LN STE 200, PISCATAWAY, NJ 08854-4143
(732) 660-8029
(732) 358-2921
Mailing address
371 HOES LN STE 200, PISCATAWAY, NJ 08854-4143
(732) 660-8029
(732) 358-2921
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881653608
—
NJ
Enumeration date
10/25/2022
Last updated
10/25/2022
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