Healthcare Provider Details

I. General information

NPI: 1063358398
Provider Name (Legal Business Name): REBUILD HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N MAIN ST FL 3
NATICK MA
01760-1100
US

IV. Provider business mailing address

7 WHITTIER PL STE 108
BOSTON MA
02114-1408
US

V. Phone/Fax

Practice location:
  • Phone: 800-630-9869
  • Fax: 877-497-2553
Mailing address:
  • Phone: 800-630-9869
  • Fax: 877-497-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EZIOMA GBUJIE
Title or Position: PROVIDER
Credential: MD
Phone: 617-333-8428