Provider Demographics
NPI:1770205379
Name:REJUVENATE HEALTH MEDICAL, LLC
Entity type:Organization
Organization Name:REJUVENATE HEALTH MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-736-4064
Mailing Address - Street 1:53 PERSIMMONS ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7655
Mailing Address - Country:US
Mailing Address - Phone:843-757-7836
Mailing Address - Fax:843-757-7837
Practice Address - Street 1:53 PERSIMMONS ST STE 105
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7656
Practice Address - Country:US
Practice Address - Phone:843-757-7836
Practice Address - Fax:843-757-7837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty