Red Bank Rejuvenation

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA04251200 Issued in NJ

Legal business name

RED BANK REJUVENATION

Practice address

628 Shrewsbury Ave
Suite C
Tinton Falls, NJ 07701-4932

Phone

(732) 383-8747

Fax

(732) 268-7291

NPI assigned

May 14, 2013

Last updated

May 14, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Eugene Desimone, M.D.

Title

Medical Director

Phone

(732) 383-8747

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1368489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1225474521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 SHREWSBURY AVE",
            "address_2": "SUITE C",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077014932",
            "telephone_number": "732-383-8747",
            "fax_number": "732-268-7291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 SHREWSBURY AVE",
            "address_2": "SUITE C",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077014932",
            "telephone_number": "732-383-8747",
            "fax_number": "732-268-7291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED BANK REJUVENATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-14",
        "last_updated": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "DESIMONE",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "732-383-8747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA04251200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Tinton Falls, NJ
• Providers in Tinton Falls, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; 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.