Organization
REVITALIZE CNY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA M. SETTER APRN-BC, DCNP (OWNER)
(315) 251-1234
Entity
Organization
Contact information
Practice address
6800 E GENESEE ST, SUITE 1200, FAYETTEVILLE, NY 13066-1089
(315) 251-1234
(315) 251-1144
Mailing address
6800 E GENESEE ST, SUITE 1200, FAYETTEVILLE, NY 13066-1089
(315) 251-1234
(315) 251-1144
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
F335679
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3835536
—
NY
Enumeration date
02/03/2016
Last updated
02/03/2016
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