Revive by Carolina, Inc

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

Legal business name

REVIVE BY CAROLINA, INC

Practice address

1086 Teaneck Rd Ste 4F1
Teaneck, NJ 07666-4857

Phone

(201) 916-9544

NPI assigned

Jul 13, 2023

Organization subpart

No

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

Authorized official

Name

Mrs. Sandres Martinez

Title

Manager

Phone

(201) 916-9544

Specialties & licenses 1

Addresses

Other names 1

• Jersey Hydreigth Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pan Sok Ko, M.D.

  • Infectious Disease Physician
  • Englewood Cliffs, NJ
  • NPI 1083851687
  Medicare reassignment NPD

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

{
    "created_epoch": "1689206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1194404574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1086 TEANECK RD STE 4F1",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664857",
            "telephone_number": "201-916-9544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1086 TEANECK RD STE 4F1",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664857",
            "telephone_number": "201-916-9544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE BY CAROLINA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-13",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "SANDRES",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "201-916-9544",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jersey Hydreigth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Florence Remes, L.C.S.W.
• Renal Medicine Associates, PA
• Nicole Rengifo
• Alexandra Susan Renzi, M.D.
• Julia Resnick
• Marifi Cali Reyes
• Stephanie Antonia Reynolds, GNP-BC, ACHPN
• Rha Health Services NJ LLC
• Rheumatology Associates of North Jersey
• Rheumatology Associates of North Jersey

• Infectious Disease Physician in Teaneck, NJ
• Providers in Teaneck, NJ by specialty
• Infectious Disease Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.