Organization
REVITALIZE MEDICAL AESTHETICS AND WELLNESS SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIMALIE RODRIGO MD (OWNER OF ENTITY)
(732) 835-2209
Entity
Organization
Contact information
Practice address
3435 US HIGHWAY 9 UNIT 4, FREEHOLD, NJ 07728-3285
(732) 835-2209
(848) 444-9218
Mailing address
3435 US HIGHWAY 9 UNIT 4, FREEHOLD, NJ 07728-3285
(732) 835-2209
(848) 444-9218
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
02/09/2024
Last updated
05/26/2024
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