Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Revived Medical IPA LLC

Organization Mental Health Counselor · NPI 1912644972

Revived Medical IPA LLC is a Mental Health Counselor in Brooklyn, New York. Registered with an NPI since 2022.

In the registry since
2022
Specialties on file
5
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1329 E 17th St
Brooklyn, NY 11230-6052
Phone: (917) 584-1409
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X
Mental Health Counselor Taxonomy 101YM0800X
Psychologist Taxonomy 103T00000X
Physical Therapist Taxonomy 225100000X
Occupational Therapist Taxonomy 225X00000X

Record details

NPI number1912644972
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ilya Kiblitsky — Sole Member · (917) 584-1409
NPI enumeratedMay 19, 2022
Last updated in NPPESMay 19, 2022
Certification dateMay 19, 2022
Mailing address1329 E 17th St, Brooklyn, NY 11230-6052

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