Revive Orthopedics and Wellness LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

REVIVE ORTHOPEDICS AND WELLNESS LLC

Practice address

571 Lafayette Ave
Hawthorne, NJ 07506-2424

Phone

(973) 949-6553

NPI assigned

Apr 30, 2024

Last updated

Apr 30, 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

Amanda Bobenko

Title

Office Manager

Phone

(973) 949-6553

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1841046711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 LAFAYETTE AVE",
            "city": "HAWTHORNE",
            "state": "NJ",
            "postal_code": "075062424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "571 LAFAYETTE AVE",
            "city": "HAWTHORNE",
            "state": "NJ",
            "postal_code": "075062424",
            "telephone_number": "973-949-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE ORTHOPEDICS AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "BOBENKO",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "973-949-6553"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Hawthorne, NJ
• Providers in Hawthorne, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.