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REVIVE SPINE AND PAIN CENTER
NPI 1235674912
Physical Medicine & Rehabilitation - Pain Medicine in Marlton, NJ

Active since January 04, 2017CLIA Certified · 2 labs
1001 LINCOLN DR W STE E, MARLTON, NJ 08053(856) 983-9001(856) 983-9011 Get Directions Write a Review

NPPES record last updated: January 31, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 4, 2019, Jan 5, 2017 (2 updates tracked since 2017).

About Revive Spine And Pain Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVIVE SPINE AND PAIN CENTER (NPI 1235674912) is a healthcare organization registered as a pain medicine in Marlton, New Jersey and active in the NPI registry since January 2017. The organization holds 2 active CLIA laboratory certificates, maintains 2 additional practice locations, and lists Mike Nammour, Manager, as its authorized official.

NPPES Registry Identity

NPI1235674912
Entity TypeOrganization
Primary Taxonomy2081P2900X
Legal Business NameREVIVE SPINE AND PAIN CENTER
Location Address1001 LINCOLN DR W STE EMarlton, NJ 08053-1534
Mailing AddressPo Box 1126Absecon, NJ 08201-5126 · (856) 983-9001 · Fax (856) 983-9011
Phone(856) 983-9001
Fax(856) 983-9011
Organization SubpartNo
Authorized OfficialMike NammourManager · (856) 983-9001
Enumeration DateJanuary 4, 2017
Last NPPES UpdateJanuary 31, 20242 updates tracked since enumeration
NPPES CertifiedJanuary 31, 2024
✔ NPI 1235674912 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysical Medicine & Rehabilitation · Pain MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2081P2900X
Definition
A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists.
1001 LINCOLN DR W STE E, Marlton, NJ 08053
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Secondary Practice Locations 2

Location 11245 Whitehorse Mercerville Rd Ste 407Hamilton, NJ 08619-3831 · Phone (609) 581-2400 · Fax (609) 581-2500
Location 2555 Route 18 Ste 201East Brunswick, NJ 08816-3727 · Phone (732) 955-9139 · Fax (732) 387-8594

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter Health of Delaware.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 31D2133848

Revive Spine And Pain Center · Marlton, NJ
Active · expires Feb 22, 2028
CLIA Number31D2133848
Laboratory TypePhysician Office
Certificate Effective DateFebruary 23, 2026
Certificate Expiration DateFebruary 22, 2028
Laboratory DirectorSamip R. Bhattarai
Laboratory Phone(856) 983-9001
Laboratory LocationRevive Spine And Pain Center1001 Lincoln Drive West Suite E/F, Marlton, NJ 08053
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 31D2125039

Revive Spine And Pain Center · East Brunswick, NJ
Active · expires Jan 30, 2027
CLIA Number31D2125039
Laboratory TypePhysician Office
Certificate Effective DateJanuary 31, 2025
Certificate Expiration DateJanuary 30, 2027
Laboratory DirectorMahmud M. Ibrahim
Laboratory Phone(732) 955-9139
Laboratory LocationRevive Spine And Pain Center555 Rt 18 Suite 202, East Brunswick, NJ 08816
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SELORM TAKYI MD
Physical Medicine & Rehabilitation
1001 LINCOLN DR W STE E
MARLTON, NJ 08053
Burlington County (856) 983-9001
REVIVE SPINE AND PAIN CENTER
Physical Medicine & Rehabilitation (Sports Medicine)
1001 LINCOLN DR W STE E
MARLTON, NJ 08053
Burlington County (856) 983-9001

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revive Spine And Pain Center's NPI number?

The NPI number for Revive Spine And Pain Center is 1235674912. It was assigned to this organization in the NPPES registry on January 4, 2017.

Where is Revive Spine And Pain Center located?

Revive Spine And Pain Center is located at 1001 Lincoln Dr W Ste E, Marlton, NJ 08053. The listed phone number is (856) 983-9001.

What is Revive Spine And Pain Center's specialty?

The primary specialty registered for this NPI is Physical Medicine & Rehabilitation, specializing in Pain Medicine, with taxonomy code 2081P2900X.

Does Revive Spine And Pain Center hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Revive Spine And Pain Center accept?

Health plans from Ambetter Health and Ambetter Health of Delaware list Revive Spine And Pain Center as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Revive Spine And Pain Center was last updated on January 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.