Organization
PSYCHE REVIVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN JAEGER MD (FOUNDING PHYSICIAN)
(347) 721-5590
Entity
Organization
Contact information
Practice address
4 SWIMMING RIVER RD STE 101, LINCROFT, NJ 07738-1727
(646) 708-3846
Mailing address
30 LA JOLLA CT, HOLMDEL, NJ 07733-2520
(347) 721-5590
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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