REVITALIZE CNY, LLC (NPI# 1396103438) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396103438 |
| Entity Type | Organization |
| Organization Name | REVITALIZE CNY, LLC |
| Practice Address |
6800 E Genesee St Suite 1200 Fayetteville NY 13066-1089 |
| Practice Telephone | 3152511234 |
| Practice Fax Number | 3152511144 |
| Mailing Telephone | 3152511234 |
| Mailing Fax Number | 3152511144 |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2016-02-03 |
| Authorized Official Name | THERESA M. SETTER (OWNER) |
| Authorized Official Telephone | 3152511234 |
| Authorized Official Credential | APRN-BC, DCNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
F335679 | NY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 3835536 | 05 |
| Street Address |
6800 E GENESEE ST SUITE 1200 |
| City | FAYETTEVILLE |
| State | NY |
| Zip Code | 13066-1089 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750387130 | Cynthia J Tremblay | Nurse Practitioner | 6800 E Genesee St, Fayetteville, NY 13066-1089 | 2005-06-22 |
| 1073076477 | Irving Sterman | Orthopaedic Surgery | 6800 E Genesee St, Fayetteville, NY 13066-1089 | 2019-04-11 |
| 1235527870 | Julie C Cannizzo | Nurse Practitioner | 6800 E Genesee St, Suite 1501, Fayetteville, NY 13066 | 2015-01-06 |
| 1417356940 | Julie R Berube | Physical Therapist | 6800 E Genesee St, Fayetteville, NY 13066-1089 | 2014-08-20 |
| 1982024204 | Syracuse Orthopedic Specialists, PC | Physical Therapist | 6800 E Genesee St, Fayetteville, NY 13066-1089 | 2014-04-25 |
| 1174940696 | Medical Weight Loss of New York, Pllc | Internal Medicine | 6800 E Genesee St, Suite 1501, Fayetteville, NY 13066-1089 | 2014-03-21 |
| 1518301134 | Sheila Mcguire | Nurse Practitioner | 6800 E Genesee St, Fayetteville, NY 13066-1089 | 2013-04-25 |
| 1215980339 | George Barrett | Physical Therapist | 6800 E Genesee St, Suite A, Fayetteville, NY 13066-1089 | 2006-05-18 |
| 1932168358 | Nicola Argese | Physical Therapist | 6800 E Genesee St, Fayetteville, NY 13066-1089 | 2006-03-23 |
| 1790752780 | Robert Cady | Orthopaedic Surgery | 6800 E Genesee St, Suite 1501, Fayetteville, NY 13066-1089 | 2006-03-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457819963 | Word Wellness Center, LLC | Psychologist | 6836 E Genesee Street, Suite A, Fayetteville, NY 13066 | 2019-03-05 |
| 1629529060 | Lorna Boyer Chase | Marriage & Family Therapist | 109 White Heron Circle, Fayetteville, NY 13066 | 2016-10-20 |
| 1699221432 | Roman Batyuk | Nurse Practitioner | 4100 Medical Center Drive, Fayetteville, NY 13066 | 2016-08-31 |
| 1427405133 | National Eye Care, Inc | Optometrist | 5160 Kinloch Circle, Fayetteville, NY 13066 | 2016-05-23 |
| 1013375328 | Kristin Kukenberger | Chiropractor | 7000 E Genesee St Bldg B, Fayetteville, NY 13066 | 2016-02-01 |
| 1124394671 | Susan Hartman Brenizer | Marriage & Family Therapist | 7000 E Genesee St Lyndon Office Park, Bldg. A, Second Floor (upper Level), Fayetteville, NY 13066 | 2012-03-29 |
| 1245541432 | Rene L Converse | Occupational Therapist | 7200 E. Genesee Street, Fayetteville, NY 13066 | 2010-06-23 |
| 1689815805 | Menorah Park Group Residents | Clinic/Center | 12 Jamar Drive, Dewitt, NY 13066 | 2009-03-18 |
| 1063677458 | John Marcena Glezen | Obstetrics & Gynecology | 1 The Gazebo, Fayetteville, NY 13066 | 2008-07-24 |
| 1629232418 | Tucker Martin Harris | Otolaryngology | 4000 Medical Center Dr # 117, Fayetteville, NY 13066 | 2008-07-11 |
| Find all providers in zip 13066 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| 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). |
| Notes: [7/1/2003: new] |
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| 1598796229 | Murchison Family Medicine, Pllc | Clinic/Center | 2110 Murchison Rd, Fayetteville, NC 28301-3644 | 2006-07-05 |
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| 1912293994 | Graham Chiropractic & Health | Clinic/Center | 5851 Ramsey St, Fayetteville, NC 28311-3475 | 2011-06-28 |
| 1013150820 | Rheumatology Arthritis Cente, Inc. | Clinic/Center | 1260 Highway 54 W, Suite 103, Fayetteville, GA 30214-4514 | 2009-04-08 |
| 1689810475 | Atlanta South Gynecology and Obstetrics P.C. | Clinic/Center | 500 W Lanier Ave, Ste.405, Fayetteville, GA 30214-7636 | 2008-12-29 |
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| 1184262255 | Health & Wellness Group Inc | Clinic/Center | 211 Broadway Ste 205, Lynbrook, NY 11563-3290 | 2019-12-19 |
| 1285278606 | Pure Eyecare Optometry P.C. | Clinic/Center | 10537 65th Ave Apt 4d, Forest Hills, NY 11375-1818 | 2019-10-29 |
| 1720629454 | International Travel Medicine, PC | Clinic/Center | 200 S Service Rd Ste 212, Roslyn Hts, NY 11577-2118 | 2019-10-03 |
| 1801446596 | Michael Bassiri-tehrani Md Pllc | Clinic/Center | 61 East 86th St., Practices At 86, New York, NY 10028 | 2019-09-16 |
| 1174178396 | Instant Care Np In Family Health | Clinic/Center | 89 Tennyson Dr, Nanuet, NY 10954-1039 | 2019-08-05 |
| 1811455801 | Five Borough Gastroenterology Medical Pllc | Clinic/Center | 340 W 86th St Apt 1a, New York, NY 10024-3274 | 2019-03-08 |
| 1598259996 | Ds Medical Diagnostics PC | Clinic/Center | 13249 41st Rd Ste 1c, Flushing, NY 11355-4286 | 2018-06-19 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 13066 |
Please comment or provide details below to improve the information on REVITALIZE CNY, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.