Healthcare Provider Details

I. General information

NPI: 1063137271
Provider Name (Legal Business Name): ADVANCED REJUVENATION THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CHURCH HILL RD BLDG E
NEWTOWN CT
06470-1638
US

IV. Provider business mailing address

32 CHURCH HILL RD BLDG E
NEWTOWN CT
06470-1638
US

V. Phone/Fax

Practice location:
  • Phone: 203-491-2999
  • Fax:
Mailing address:
  • Phone: 203-491-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARY GAROFALO
Title or Position: AUTHORIZED OFFCIAL
Credential: OWNER
Phone: 203-309-9378