Healthcare Provider Details

I. General information

NPI: 1942047865
Provider Name (Legal Business Name): REVOLVE MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 CENTRAL AVE
CEDARHURST NY
11516-1907
US

IV. Provider business mailing address

414 CENTRAL AVE
CEDARHURST NY
11516-1907
US

V. Phone/Fax

Practice location:
  • Phone: 347-344-7466
  • Fax:
Mailing address:
  • Phone: 347-344-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN WEISS
Title or Position: OWNER
Credential: MD
Phone: 347-344-7466