Revoredo, Fred

Revoredo, Fred is an sole proprietor health care provider with primary practice located at 425 15Th Ave , Paterson NJ 07504-1811. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Revoredo, Fred can be contacted via phone (973) 345-4155.

Contact Information

Primary practice address
425 15Th Ave Paterson NJ 07504-1811
Phone: (973) 345-4155
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 25MA07147400 New Jersey
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 25MA07147400 New Jersey

Profile Details

NPI number 1669588422
LBN Legal business name Revoredo, Fred
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 22nd, 2006
Last updated Sep 9th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669588422 NPPES
New Jersey MEDICAID 8376808

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