MEDICARE: REVOLVE MEDICAL SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center
2	174400000X	Specialist

General Provider Information

NPI Number	:	1942047865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVOLVE MEDICAL SERVICES PC

Provider Business Mailing Address
First Line	:	414 CENTRAL AVE
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1907
Country	:	US
Telephone Number	:	347-344-7466
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 CENTRAL AVE
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1907
Country	:	US
Telephone Number	:	347-344-7466
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BENJAMIN WEISS
Credential	:	MD
Telephone Number	:	347-344-7466

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	04/15/2026

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