Provider Demographics
NPI:1013475953
Name:REJUVENATION CENTER FOR MIND AND BODY
Entity type:Organization
Organization Name:REJUVENATION CENTER FOR MIND AND BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-444-4558
Mailing Address - Street 1:555 PREAKNESS AVE
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-1012
Mailing Address - Country:US
Mailing Address - Phone:973-444-4558
Mailing Address - Fax:973-444-7466
Practice Address - Street 1:555 PREAKNESS AVE
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07502-1012
Practice Address - Country:US
Practice Address - Phone:973-444-4558
Practice Address - Fax:973-444-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty