Elite Premier Medical Care LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MA07147400 Issued in NJ

Legal business name

ELITE PREMIER MEDICAL CARE LLC

Practice address

470 Chamberlain Ave Ste 7
Paterson, NJ 07522-1000

Phone

(973) 595-7400

NPI assigned

Dec 13, 2011

Last updated

Dec 13, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miryam Revoredo

Title

General Manegar

Phone

(973) 595-7400

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FAJEDD

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fred Revoredo, M.D.

  • Family Medicine Physician
  • Paterson, NJ
  • NPI 1669588422
  NPD
• Julio C Baquerizo, NURSE PRACTITIONER

  • Adult Health Nurse Practitioner
  • Woodbridge, NJ
  • NPI 1922386812
  NPD (past)
• Nadhia Celestin, M.D.

  • Family Medicine Physician
  • Gouverneur, NY
  • NPI 1861525909
  NPD (past)

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323734400000",
    "number": "1609144005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 15TH AVE STE 2",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075041811",
            "telephone_number": "973-595-7400",
            "fax_number": "973-345-4156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 CHAMBERLAIN AVE STE 7",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075221000",
            "telephone_number": "973-595-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PREMIER MEDICAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-13",
        "last_updated": "2011-12-13",
        "status": "A",
        "authorized_official_last_name": "REVOREDO",
        "authorized_official_first_name": "MIRYAM",
        "authorized_official_title_or_position": "GENERAL MANEGAR",
        "authorized_official_telephone_number": "973-595-7400"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA07147400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8376808",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peggy Eicher, M.D.
• Michael Saad Ha El Masry
• Mohammed H Elassa
• Elensa Medical II, LLC
• Elite Physicians LLC
• Saddam Elomari, PHARM-D
• Nazmi A Elrabie, MD
• Osama Ahmed Elsawy, D.O.
• Amerah M Elshayeb
• Sally Elshazly

• Family Medicine Physician in Paterson, NJ
• Providers in Paterson, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.