Provider Demographics
NPI:1063137271
Name:ADVANCED REJUVENATION THERAPY
Entity type:Organization
Organization Name:ADVANCED REJUVENATION THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFCIAL
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAROFALO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:203-309-9378
Mailing Address - Street 1:32 CHURCH HILL RD BLDG E
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1638
Mailing Address - Country:US
Mailing Address - Phone:203-491-2999
Mailing Address - Fax:
Practice Address - Street 1:32 CHURCH HILL RD BLDG E
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1638
Practice Address - Country:US
Practice Address - Phone:203-491-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty