=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093527954
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REVIVE HEALTH AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2025
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3201 BRIDGE AVE
-----------------------------------------------------
City | POINT PLEASANT BORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08742-3468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-995-5285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3201 BRIDGE AVE
-----------------------------------------------------
City | POINT PLEASANT BORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08742-3468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-995-5285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSEPH MARCHITELLI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 732-995-5285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------