Organization
ELITE PREMIER MEDICAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRYAM REVOREDO (GENERAL MANEGAR)
(973) 595-7400
Entity
Organization
Contact information
Practice address
470 CHAMBERLAIN AVE STE 7, PATERSON, NJ 07522-1000
(973) 595-7400
Mailing address
425 15TH AVE STE 2, PATERSON, NJ 07504-1811
(973) 595-7400
(973) 345-4156
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA07147400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8376808
—
NJ
Enumeration date
12/13/2011
Last updated
12/13/2011
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