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Organization
REVOREDO MEDICAL AFFILIATES LLC
Active
Organization
REVOREDO MEDICAL AFFILIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRED S REVOREDO MD (PRESIDENT)
(973) 345-4024
Entity
Organization
Contact information
Practice address
425 15TH AVE, PATERSON, NJ 07504-1811
(973) 345-4024
(973) 345-4156
Mailing address
425 15TH AVE, PATERSON, NJ 07504-1811
(973) 345-4024
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
25MA07147400
NJ
207Q00000X
Family Medicine Physician
Primary
25MA07147400
NJ
Other
Enumeration date
09/15/2009
Last updated
09/15/2009
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