Provider Demographics
NPI:1093527954
Name:REVIVE HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:REVIVE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-995-5285
Mailing Address - Street 1:3201 BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3468
Mailing Address - Country:US
Mailing Address - Phone:732-995-5285
Mailing Address - Fax:
Practice Address - Street 1:3201 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-3468
Practice Address - Country:US
Practice Address - Phone:732-995-5285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386092989OtherNPPES