Provider Demographics
NPI:1003544388
Name:REJUV AESTHETICS MD, PA
Entity Type:Organization
Organization Name:REJUV AESTHETICS MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-418-0744
Mailing Address - Street 1:85 SW 5TH AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-2511
Mailing Address - Country:US
Mailing Address - Phone:561-559-4700
Mailing Address - Fax:
Practice Address - Street 1:85 SW 5TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-2511
Practice Address - Country:US
Practice Address - Phone:561-559-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy CareGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty