Provider Demographics
NPI:1982377917
Name:REGEN MED LLC
Entity Type:Organization
Organization Name:REGEN MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-335-5210
Mailing Address - Street 1:706 STEVENSON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-5371
Mailing Address - Country:US
Mailing Address - Phone:724-335-5210
Mailing Address - Fax:
Practice Address - Street 1:706 STEVENSON BLVD
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-5371
Practice Address - Country:US
Practice Address - Phone:724-335-5210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA712021Medicaid