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REVITALIZE CNY, LLC
NPI 1396103438
Clinic/Center - Medical Specialty in Fayetteville, NY

Active since February 03, 2016CLIA 33D2115614 · Waiver
6800 E GENESEE ST, SUITE 1200, FAYETTEVILLE, NY 13066(315) 251-1234(315) 251-1144 Get Directions Write a Review

NPPES record last updated: February 3, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Revitalize Cny, Llc NPPES

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

REVITALIZE CNY, LLC (NPI 1396103438) is a healthcare organization registered as a medical specialty in Fayetteville, New York and active in the NPI registry since February 2016. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Theresa M. Setter, Owner, as its authorized official.

NPPES Registry Identity

NPI1396103438
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameREVITALIZE CNY, LLC
Location Address6800 E GENESEE ST, SUITE 1200Fayetteville, NY 13066-1089
Mailing Address6800 E Genesee St, Suite 1200Fayetteville, NY 13066-1089 · (315) 251-1234 · Fax (315) 251-1144
Phone(315) 251-1234
Fax(315) 251-1144
Organization SubpartNo
Authorized OfficialTheresa M. SetterOwner · (315) 251-1234
Enumeration DateFebruary 3, 2016
✔ NPI 1396103438 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
License✔ Licensed in NY · F335679
Definition
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).
6800 E GENESEE ST, Fayetteville, NY 13066
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Other Identifiers 2

Medicare UPINJ400085712NY
Medicaid3835536NY

CLIA Laboratory Certificates CMS CLIA

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 Waiver 33D2115614

Revitalize Cny LLC · Fayetteville, NY
Active · expires Mar 26, 2027
CLIA Number33D2115614
Laboratory TypeIndependent
Certificate Effective DateJuly 12, 2022
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Theresa M. Setter
Laboratory Phone(315) 251-1234
Laboratory LocationRevitalize Cny LLC6800 E Genesee St - Suite 1200, Fayetteville, NY 13066
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 14

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

DR. IRVING STERMAN MD
Orthopaedic Surgery
6800 E GENESEE ST
FAYETTEVILLE, NY 13066
Onondaga County (315) 474-8595
MEDICAL WEIGHT LOSS OF NEW YORK, PLLC
Family Medicine (Obesity Medicine)
6800 E GENESEE ST, SUITE 1501
FAYETTEVILLE, NY 13066
Onondaga County (315) 391-9390
MR. GEORGE BARRETT PT
Physical Therapist
6800 E GENESEE ST, SUITE A
FAYETTEVILLE, NY 13066
Onondaga County (315) 478-0380
JULIE C CANNIZZO N.P.
Nurse Practitioner (Family)
6800 E GENESEE ST, SUITE 1501
FAYETTEVILLE, NY 13066
Onondaga County (315) 445-0003
JULIE R BERUBE DPT
Physical Therapist
6800 E GENESEE ST
FAYETTEVILLE, NY 13066
Onondaga County (315) 635-5000
JESSICA ORALLO MANALANG
Physical Therapist
6800 E GENESEE ST
FAYETTEVILLE, NY 13066
Onondaga County (315) 635-5000
SHEILA MCGUIRE NP
Nurse Practitioner (Adult Health)
6800 E GENESEE ST
FAYETTEVILLE, NY 13066
Onondaga County (315) 445-0003
DEANNA MARIE DERRENBACKER PT
Physical Therapist
6800 E GENESEE ST
FAYETTEVILLE, NY 13066
Onondaga County (315) 635-5000

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 Revitalize Cny, LLC's NPI number?

The NPI number for Revitalize Cny, LLC is 1396103438. It was assigned to this organization in the NPPES registry on February 3, 2016.

Where is Revitalize Cny, LLC located?

Revitalize Cny, LLC is located at 6800 E Genesee St Suite 1200, Fayetteville, NY 13066. The listed phone number is (315) 251-1234.

What is Revitalize Cny, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Does Revitalize Cny, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2115614) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Revitalize Cny, LLC was last updated on February 3, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.