Revivify LLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

Legal business name

REVIVIFY LLC

Practice address

68 River Road
Annex
Summit, NJ 07901-1450

Phone

(908) 273-2222

NPI assigned

Dec 20, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marco Dimayorca, PARAMEDIC

Title

Managing Member

Phone

(908) 273-2222

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639958400000",
    "number": "1063172880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 RIVER ROAD",
            "address_2": "ANNEX",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079011450",
            "telephone_number": "908-273-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 RIVER ROAD",
            "address_2": "ANNEX",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079011450",
            "telephone_number": "908-273-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVIFY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-20",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A",
        "authorized_official_last_name": "DIMAYORCA",
        "authorized_official_first_name": "MARCO",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "908-273-2222",
        "authorized_official_credential": "PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://api.mindbodyonline.com/0_5/AppointmentService.asmx",
            "affiliation": "N",
            "endpointDescription": "Appointment Service",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "XML",
            "address_1": "68 River Road",
            "address_2": "Annex",
            "city": "Summit",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "07901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Summit, NJ
• Providers in Summit, NJ by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.