Revive Spine and Pain Center

Primary specialty

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

Legal business name

REVIVE SPINE AND PAIN CENTER

Practice address

1001 Lincoln Dr W Ste E
Marlton, NJ 08053-1534

Phone

(856) 983-9001

Fax

(856) 983-9011

NPI assigned

Jan 4, 2017

Last updated

Jan 31, 2024By 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

Mike Nammour

Title

Manager

Phone

(856) 983-9001

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1235674912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1126",
            "city": "ABSECON",
            "state": "NJ",
            "postal_code": "082015126",
            "telephone_number": "856-983-9001",
            "fax_number": "856-983-9011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 LINCOLN DR W STE E",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080531534",
            "telephone_number": "856-983-9001",
            "fax_number": "856-983-9011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 Route 18 Ste 201",
            "address_purpose": "LOCATION",
            "city": "East Brunswick",
            "state": "NJ",
            "postal_code": "088163727",
            "country_code": "US",
            "telephone_number": "732-955-9139",
            "fax_number": "732-387-8594",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1245 Whitehorse Mercerville Rd Ste 407",
            "address_purpose": "LOCATION",
            "city": "Hamilton",
            "state": "NJ",
            "postal_code": "086193831",
            "country_code": "US",
            "telephone_number": "609-581-2400",
            "fax_number": "609-581-2500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVE SPINE AND PAIN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-04",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "NAMMOUR",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "856-983-9001"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Resonance Center for Chinese Medicine LLC
• Restore Physical Therapy, LLC
• Kelly Ann Rettberg, LPC
• Revascmedprofessional NJ LLC (Revamp)
• Revive & Thrive Counseling
• Revive Spine and Pain Center
• James Reyes, APN
• Samantha Elizabeth Reynolds, M.S. ATC LAT
• Tara Reynolds, LPC
• Syed A. Riaz, M.D.

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Marlton, NJ
• Providers in Marlton, 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 Jan 31, 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.