Individual
JUAN CARLOS REVELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 334-3507
(718) 334-5006
Mailing address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 334-3507
(718) 334-5006
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403827
NY
Other
Enumeration date
06/05/2023
Last updated
06/09/2023
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