Revive Health and Aesthetics PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

REVIVE HEALTH AND AESTHETICS PC

Practice address

294 N Main St
East Longmeadow, MA 01028-1838

Phone

(413) 224-1009

NPI assigned

Sep 30, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Adekunle A. Fajana, MD

Title

President

Phone

(508) 735-3280

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1727654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1104644145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "294 N MAIN ST",
            "city": "EAST LONGMEADOW",
            "state": "MA",
            "postal_code": "010281838",
            "telephone_number": "413-224-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "294 N MAIN ST",
            "city": "EAST LONGMEADOW",
            "state": "MA",
            "postal_code": "010281838",
            "telephone_number": "413-224-1009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE HEALTH AND AESTHETICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-30",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "FAJANA",
        "authorized_official_first_name": "ADEKUNLE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "508-735-3280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina M Quinlivan
• Rachael Simmons LLC
• Raymond D.Manniello,D.D.S.,P.C.
• Kathleen A Reid, NP
• Julia Diane Reilly, D.M.D.
• Taina Reyes
• Katherine Mary Rice, PA-C
• Robert Howe, MD, PC
• Nathanael L Rosario, CRNA
• Karyn M Rosenkranz, PT, DPT

• Dermatology Physician in East Longmeadow, MA
• Providers in East Longmeadow, MA by specialty
• Dermatology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; 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.