Healthcare Provider Details

I. General information

NPI: 1699311845
Provider Name (Legal Business Name): REJUVYO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S 3RD ST STE 210
COLUMBUS OH
43215-4206
US

IV. Provider business mailing address

1735 MARKET ST STE 3750
PHILADELPHIA PA
19103-7532
US

V. Phone/Fax

Practice location:
  • Phone: 614-296-4941
  • Fax:
Mailing address:
  • Phone: 866-735-8896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA ZITOMER
Title or Position: EVP
Credential:
Phone: 215-858-3142