REVITALIZE CNY, LLC is a medical specialty clinic center in Fayetteville, NY. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). REVITALIZE CNY, LLC NPI is 1396103438. The provider is registered as an organization entity type.
The provider's business location address is:
6800 E GENESEE ST
SUITE 1200
FAYETTEVILLE, NY
ZIP 13066-089
Phone: (315) 251-1234
Fax: (315) 251-1144
The provider's authorized official is Theresa M. Setter .
The authorized official title is Owner and has the following contact phone number (315) 251-1234.
The CLIA number assigned to this NPI record is 33D2115614 - independent with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 2/3/2016 and was last updated on 2/3/2016.