NPIMap

Organization Active NPI

Revive Spine and Pain Center

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Marlton, NJ
National Provider Identifier
1457896003
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
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 5, 2017
Last updated
Jan 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Authorized official

Name
Dr. Michael Rizkalla, MDNPI 1477717791
Title
Director
Phone
(856) 983-9001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2081S0010X Primary
Pain Clinic/Center 261QP3300X 25MA08922900 NJ

Addresses

Primary practice location

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

Mailing address

PO Box 1126
Absecon, NJ 08201
Phone (856) 983-9001

Other practice location 1

1245 Whitehorse Mercerville Rd Ste 407
Hamilton, NJ 08619-3831
Phone (609) 581-2400

Other practice location 2

555 Route 18 Ste 201
East Brunswick, NJ 08816-3727
Phone (732) 955-9139

National Provider Directory

National Provider Directory

Locations

555 Route 18
Ste 201
East Brunswick, NJ 08816
Phone (732) 955-9139

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1457896003",
    "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": "08201",
            "telephone_number": "856-983-9001"
        },
        {
            "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": "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"
        },
        {
            "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"
        }
    ],
    "basic": {
        "organization_name": "REVIVE SPINE AND PAIN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-05",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "RIZKALLA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "856-983-9001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NJ",
            "license": "25MA08922900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

  • 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.