Provider Demographics
NPI:1689364408
Name:REVIVE NEURAL HEALTH
Entity Type:Organization
Organization Name:REVIVE NEURAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-348-9337
Mailing Address - Street 1:3129 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2642
Mailing Address - Country:US
Mailing Address - Phone:646-662-1058
Mailing Address - Fax:270-203-0587
Practice Address - Street 1:SCHOOL HOUSE VILLAGE, SUITE 9
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921
Practice Address - Country:US
Practice Address - Phone:973-348-9337
Practice Address - Fax:270-203-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service