Fred Rezvani

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA05115800 Issued in NJ

Practice address

119 Prospect St
1St Floor Suite 1
Ridgewood, NJ 07450-4405

Phone

(201) 444-1600

Fax

(201) 444-8774

NPI assigned

Apr 1, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 4, 2021 through Oct 4, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fred Rezvani GYN LLC

  • Obstetrics & Gynecology Physician
  • Ridgewood, NJ
  • NPI 1396550463
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746489600000",
    "number": "1104887694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 PROSPECT ST",
            "address_2": "1ST FLOOR SUITE 1",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074504405",
            "telephone_number": "201-444-1600",
            "fax_number": "201-444-8774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 PROSPECT ST",
            "address_2": "1ST FLOOR SUITE 1",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074504405",
            "telephone_number": "201-444-1600",
            "fax_number": "201-444-8774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZVANI",
        "first_name": "FRED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-01",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA05115800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BC/BS OF NY",
            "identifier": "30G161",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO #",
            "identifier": "4226530",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET #",
            "identifier": "0K6927",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD ID#",
            "identifier": "BP204",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH #",
            "identifier": "0562861001",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO #",
            "identifier": "0028398",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dennis S Reison, MD
• Travis L Reiter, DPT
• Rem New Jersey, Inc.
• Retina Consultants, PA, II
• Gladys Reyes, APN
• Rhoda H Cobin MD PA
• Rhoda H. Cobin MD PA
• Aarezo Riaz
• Richard Dow LMSW PC
• Richard Gaines, PH.D., LLC

• Specialist in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.