| Revival Health Services Llc | |
|
21065 Powerline Rd Ste 35 Boca Raton FL 33433-2313 | |
| (561) 484-2947 | |
| Not Available |
| Full Name | Revival Health Services Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 21065 Powerline Rd Ste 35, Boca Raton, Florida |
| Authorized Official Name and Position | Camila Mendez (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 6469210872 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revival Health Services Llc 20980 Cipres Way Boca Raton FL 33433-1604 Ph: (646) 921-0872 | Revival Health Services Llc 21065 Powerline Rd Ste 35 Boca Raton FL 33433-2313 Ph: (561) 484-2947 |
| NPI Number | 1669165197 |
|---|---|
| Provider Enumeration Date | 05/31/2023 |
| Last Update Date | 01/02/2024 |
| Medicare PECOS PAC ID | 0840649018 |
|---|---|
| Medicare Enrollment ID | O20231213001462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669165197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gabor Menczelesz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609869833 PECOS PAC ID: 9032147434 Enrollment ID: I20170104001864 |
| Provider Name | Andrew D Bennett |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1043607518 PECOS PAC ID: 0547504532 Enrollment ID: I20200819002817 |
| Provider Name | Shoshana B Kassorla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912504051 PECOS PAC ID: 1456764661 Enrollment ID: I20210107001976 |
| Provider Name | Benjamin Neuman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881212009 PECOS PAC ID: 2365846466 Enrollment ID: I20210811004074 |
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