DR. FRED REVOREDO (NPI# 1669588422) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669588422 |
| Entity Type | Individual |
| Full Name | DR. FRED REVOREDO |
| Credential | M.D. |
| Practice Address |
425 15th Ave Paterson NJ 07504-1811 |
| Mailing Address |
425 15th Avenue Paterson NJ 07504-1811 |
| Practice Telephone | 9733454155 |
| Mailing Telephone | 9733454155 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2009-09-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 25MA07147400 | NJ | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 25MA07147400 | NJ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 8376808 | 05 |
| Street Address |
425 15TH AVE |
| City | PATERSON |
| State | NJ |
| Zip Code | 07504-1811 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124333901 | Jorge L Revoredo | Family Medicine | 425 15th Ave, Paterson, NJ 07504-1811 | 2010-08-17 |
| 1881927358 | Revoredo Medical Affiliates LLC | Emergency Medicine | 425 15th Ave, Paterson, NJ 07504-1811 | 2009-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881051696 | Jacqueline Yvonne Ghee | Social Worker | 612 14th Ave., Clifton, NJ 07504 | 2016-01-25 |
| 1962723429 | Karen L Douglas | Counselor | 253 18th Avenue, Paterson, NJ 07504 | 2010-06-18 |
| 1235303934 | Cherryl Lewis-berry | Licensed Practical Nurse | 284 Wall Ave, Patterson, NY 07504 | 2008-04-15 |
| 1760672380 | Jonathan Bruce Spages | Chiropractor | 234 Mclean Blvd, Paterson, NJ 07504 | 2007-07-30 |
| 1417147257 | David Neal Rendelstein | Chiropractor | 234 Mclean Blvd, Paterson, NJ 07504 | 2007-07-27 |
| 1346309754 | Nart Tsay | Chiropractor | 567 Park Ave, Paterson, NJ 07504 | 2006-12-08 |
| 1154566198 | Rehan Hassanin Seyam | Counselor | 152 Derrom Ave, Paterson, NJ 07504-1003 | 2008-12-04 |
| 1780134783 | Bryant Flores | Chiropractor | 567 Park Ave, Paterson, NJ 07504-1006 | 2016-10-13 |
| 1508928748 | Kamel Kazan | Chiropractor | 567 Park Ave, Paterson, NJ 07504-1006 | 2006-12-14 |
| 1174021596 | Echo Care LLC | Home Health | 244 Wall Ave, Paterson, NJ 07504-1016 | 2018-01-31 |
| Find all providers in zip 07504 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902313315 | Premiere Medical Group Associates | Family Medicine | 546 14th Ave, Paterson, NJ 07504-2206 | 2018-01-08 |
| 1427452465 | Shideh Doroudi | Family Medicine | 1020 Main St Ste C, Paterson, NJ 07503-2244 | 2014-10-20 |
| 1609144005 | Elite Premier Medical Care LLC | Family Medicine | 470 Chamberlain Ave Ste 7, Paterson, NJ 07522-1000 | 2011-12-13 |
| 1245368554 | Riva Kaynan | Family Medicine | 234 Mclean Blvd, Paterson, NJ 07504-1021 | 2007-02-28 |
| 1548374747 | Hasna Kazmouz | Family Medicine | 7 Lee Pl, Paterson, NJ 07505-1803 | 2006-08-18 |
| 1235108135 | Rafael Paz | Family Medicine | 424 River St, Paterson, NJ 07524 | 2006-03-15 |
| 1144737529 | Rl Medical Corporation | Family Medicine | 543 14th Ave, Paterson, NJ 07504-2205 | 2018-01-07 |
| 1043602303 | Family Care of New Jersey | Family Medicine | 1042 Main St, Paterson, NJ 07503-2212 | 2015-02-24 |
| 1700126299 | Nj Medical Professionals LLC | Family Medicine | 1020 Main St, Suite C, Paterson, NJ 07503-2244 | 2013-02-21 |
| 1609163716 | 21st Avenue Primary Care Pa | Family Medicine | 534 21st Ave, Paterson, NJ 07513-1337 | 2011-07-09 |
| Find all providers in PATERSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.