| Revived Medical Ipa Llc | |
|
1329 E 17th St Brooklyn NY 11230-6052 | |
| (917) 584-1409 | |
| Not Available |
| Full Name | Revived Medical Ipa Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1329 E 17th St, Brooklyn, New York |
| Authorized Official Name and Position | Ilya Kiblitsky (SOLE MEMBER) |
| Authorized Official Contact | 9175841409 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revived Medical Ipa Llc 1329 E 17th St Brooklyn NY 11230-6052 Ph: () - | Revived Medical Ipa Llc 1329 E 17th St Brooklyn NY 11230-6052 Ph: (917) 584-1409 |
| NPI Number | 1912644972 |
|---|---|
| Provider Enumeration Date | 05/19/2022 |
| Last Update Date | 05/19/2022 |
| Certification Date | 05/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912644972 | NPI | - | NPPES |
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