Revitalize Cny, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

F335679 Issued in NY

Legal business name

REVITALIZE CNY, LLC

Practice address

6800 E Genesee St
Suite 1200
Fayetteville, NY 13066-1089

Phone

(315) 251-1234

Fax

(315) 251-1144

NPI assigned

Feb 3, 2016

Last updated

Feb 3, 2016By 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

Theresa M. Setter, APRN-BC, DCNPNPI 1114135209

Title

Owner

Phone

(315) 251-1234

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Theresa M. Setter, APRN-BC

  • Family Nurse Practitioner
  • Fayetteville, NY
  • NPI 1114135209
  Authorized official Same address or phone

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

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454457600000",
    "number": "1396103438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 E GENESEE ST",
            "address_2": "SUITE 1200",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661089",
            "telephone_number": "315-251-1234",
            "fax_number": "315-251-1144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 E GENESEE ST",
            "address_2": "SUITE 1200",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661089",
            "telephone_number": "315-251-1234",
            "fax_number": "315-251-1144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE CNY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-03",
        "last_updated": "2016-02-03",
        "status": "A",
        "authorized_official_last_name": "SETTER",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-251-1234",
        "authorized_official_credential": "APRN-BC, DCNP"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NY",
            "license": "F335679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3835536",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William C Redfield, MSW, M. DIV.
• Marilyn E Rees, MPS
• Simone Reid, DDS
• Maria Andrea Reinking, PH.D.
• Reverie Creative Arts Therapy Services, PLLC
• David Dominick Riccardi, MD
• Dawn C Richardson, MD
• Right Size Kids, Inc.
• Cami K Riley, MD
• Marley M Rinoldo, DDS

• Medical Specialty Clinic/Center in Fayetteville, NY
• Providers in Fayetteville, NY by specialty
• Medical Specialty Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.