Health Revival Medical PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

223381 Issued in NY

Legal business name

HEALTH REVIVAL MEDICAL PC

Practice address

Health Revival Medical PC
162 Brighton Street
Brooklyn, NY 11235-5237

Phone

(718) 891-8822

Fax

(718) 891-8823

NPI assigned

Jun 27, 2006

Organization subpart

No

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

Authorized official

Name

Larisa Veksman, MDNPI 1003843061

Title

Medical Director

Phone

(718) 891-8822

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Larisa Veksman, MD

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1003843061
  Authorized official Same address or phone

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093742900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 GOODAL STREET",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "103083325",
            "telephone_number": "718-891-8822",
            "fax_number": "718-891-8823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HEALTH REVIVAL MEDICAL PC",
            "address_2": "162 BRIGHTON STREET",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355237",
            "telephone_number": "718-891-8822",
            "fax_number": "718-891-8823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH REVIVAL MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VEKSMAN",
        "authorized_official_first_name": "LARISA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "718-891-8822",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "223381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Brooklyn, NY
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• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.