Ketarevive, Inc

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

KETAREVIVE, INC

Practice address

541 Cedar Hill Ave
2ND Floor
Wyckoff, NJ 07481

Phone

(201) 212-6735

NPI assigned

Jul 17, 2024

Organization subpart

No

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

Authorized official

Name

Joseph Affortunato, DONPI 1902064199

Title

Partner

Phone

(516) 225-3336

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph Affortunato, D.O.

  • Emergency Medicine Physician
  • Franklin Lakes, NJ
  • NPI 1902064199
  Medicare reassignment NPD Authorized official
• Jerome Edward Balbin, M.D.

  • Emergency Medicine Physician
  • Paterson, NJ
  • NPI 1043638638
  Medicare reassignment NPD

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

{
    "created_epoch": "1721174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742256000000",
    "number": "1235977893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 ROXBURY RD",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074301641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 CEDAR HILL AVE",
            "address_2": "2ND FLOOR",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "07481",
            "telephone_number": "201-212-6735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAREVIVE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-17",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A",
        "authorized_official_last_name": "AFFORTUNATO",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "516-225-3336",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tashil Kim Ju, MD
• Kaitlyn Personette LLC
• Kaminsky Chiropractic LLC
• Kathleen Galasso LCSW
• Sukhpal Kaur
• Ketavita Wellness Clinic PC
• Melissa Kiel, MS
• Tina Ahn Kim, PHARMD
• Yoon-Hee Kim, PHARM.D.
• Janelle Diana King, LMT

• Emergency Medicine Physician in Wyckoff, NJ
• Providers in Wyckoff, NJ by specialty
• Emergency Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.