Healthcare Provider Details

I. General information

NPI: 1265356935
Provider Name (Legal Business Name): REVIVE MEDTECH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BROADHOLLOW RD STE 305
MELVILLE NY
11747-5018
US

IV. Provider business mailing address

555 BROADHOLLOW RD STE 305
MELVILLE NY
11747-5018
US

V. Phone/Fax

Practice location:
  • Phone: 631-759-5655
  • Fax: 631-759-5655
Mailing address:
  • Phone: 631-759-5655
  • Fax: 631-759-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SANJEEV KUMAR
Title or Position: MANAGER
Credential:
Phone: 631-759-5655