Individual
DR. FRED REVOREDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
425 15TH AVE, PATERSON, NJ 07504-1811
(973) 345-4155
Mailing address
425 15TH AVENUE, PATERSON, NJ 07504-1811
(973) 345-4155
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
25MA07147400
NJ
207Q00000X
Family Medicine Physician
Primary
25MA07147400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8376808
—
NJ
Enumeration date
08/22/2006
Last updated
07/29/2024
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