Provider Demographics
NPI:1679266332
Name:REJUVENTIONS
Entity type:Organization
Organization Name:REJUVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCHESKIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-438-2578
Mailing Address - Street 1:190 S GREENWOOD AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2548
Mailing Address - Country:US
Mailing Address - Phone:610-438-2578
Mailing Address - Fax:
Practice Address - Street 1:190 S GREENWOOD AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2548
Practice Address - Country:US
Practice Address - Phone:610-438-2578
Practice Address - Fax:610-438-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty