Psyche Revive LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

PSYCHE REVIVE LLC

Practice address

4 Swimming River Rd Ste 101
Lincroft, NJ 07738-1727

Phone

(646) 708-3846

NPI assigned

Aug 18, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Stephen Jaeger, MDNPI 1578917753

Title

Founding Physician

Phone

(347) 721-5590

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Stephen Jospeh Jaeger Jr., MD

  • Psychiatry Physician
  • Lincroft, NJ
  • NPI 1578917753
  NPD Authorized official

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1376219402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 LA JOLLA CT",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077332520",
            "telephone_number": "347-721-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 SWIMMING RIVER RD STE 101",
            "city": "LINCROFT",
            "state": "NJ",
            "postal_code": "077381727",
            "telephone_number": "646-708-3846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHE REVIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "JAEGER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "FOUNDING PHYSICIAN",
        "authorized_official_telephone_number": "347-721-5590",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Joseph Pittarelli, PT
• Pjo Orthopedic Supplies LLC
• Frank V. Porco, M.D.
• Marisa Priolo, PT, DPT
• Progressive Physical Rehabilitation
• Alberto Olivas Quiambao, RNFA
• Alexandra Raguseo, DPT, PT
• Linda Rembisz
• Kerri Marie Restaino, MS CCC-SLP
• Eliya Rivkin, BCBA

• Psychiatry Physician in Lincroft, NJ
• Providers in Lincroft, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; 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.