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Revitalize Cny, Llc
Medical Specialty Clinic/Center in Fayetteville, New York
NPI 1396103438

Revitalize Cny, Llc is a Medical Specialty Clinic/Center based in Fayetteville, NY and is specialized in Medical Specialty. Revitalize Cny, Llc practices in Fayetteville, NY. The NPI Number for Revitalize Cny, Llc is 1396103438 and holds a License No. F335679 (New York).

The current practice location address for Revitalize Cny, Llc is 6800 E Genesee St, Fayetteville, NY and can be reached out via phone at 315-251-1234 and via fax at 315-251-1144.

Location: 6800 E Genesee St, Fayetteville, NY, 13066-1089
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1396103438
Provider Name
Revitalize Cny, Llc
Credential
Provider Entity Type
Organization
Address
6800 E Genesee St, Fayetteville, NY, 13066-1089
Phone Number
315-251-1234
Fax Number
315-251-1144
Provider Enumeration Date
02/03/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
3835536 05 NY
institution
Provider Business Practice Location Address Details
Address
6800 E Genesee St
City
Fayetteville
State
New York
Zip
13066-1089
Phone Number
315-251-1234
Fax Number
315-251-1144
person
Provider Business Mailing Address Details
Address
6800 E Genesee St
City
Fayetteville
State
New York
Zip
13066-1089
Phone Number
315-251-1234
Fax Number
315-251-1144
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Medical Specialty
Taxonomy
261QM2500X
License No.
F335679 (New York)
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
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