Revital Retreat, LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

REVITAL RETREAT, LLC

Practice address

371 Hoes LN Ste 200
Piscataway, NJ 08854-4143

Phone

(732) 660-8029

Fax

(732) 358-2921

NPI assigned

Oct 25, 2022

Last updated

Oct 25, 2022By 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

Evelyn Javier, APRN

Title

Advance Practice Nurse/ Owner

Phone

(732) 589-9388

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1366169989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "371 HOES LN STE 200",
            "city": "PISCATAWAY",
            "state": "NJ",
            "postal_code": "088544143",
            "telephone_number": "732-660-8029",
            "fax_number": "732-358-2921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 HOES LN STE 200",
            "city": "PISCATAWAY",
            "state": "NJ",
            "postal_code": "088544143",
            "telephone_number": "732-660-8029",
            "fax_number": "732-358-2921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITAL RETREAT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-25",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "JAVIER",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_title_or_position": "ADVANCE PRACTICE NURSE/ OWNER",
        "authorized_official_telephone_number": "732-589-9388",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881653608",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://static.practicefusion.com/apps/ehr/index.html#/login",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "address_1": "371 Hoes Ln Ste 200",
            "city": "Piscataway",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "088544143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Health Service Clinic/Center in Piscataway, NJ
• Providers in Piscataway, NJ by specialty
• Health Service Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.