Individual
FRED REZVANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
119 PROSPECT ST, 1ST FLOOR SUITE 1, RIDGEWOOD, NJ 07450-4405
(201) 444-1600
(201) 444-8774
Mailing address
119 PROSPECT ST, 1ST FLOOR SUITE 1, RIDGEWOOD, NJ 07450-4405
(201) 444-1600
(201) 444-8774
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA05115800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0028398
AETNA HMO #
NJ
01
—
0562861001
AMERIHEALTH #
NJ
01
—
0K6927
HEALTHNET #
NJ
01
—
30G161
EMPIRE BC/BS OF NY
NJ
01
—
4226530
AETNA PPO #
NJ
01
—
BP204
OXFORD ID#
NJ
Enumeration date
04/01/2006
Last updated
05/06/2025
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