Active NPI
Samuel Luis Reveron, PHARMD
- Pharmacotherapy Pharmacist
- North Bergen, NJ
National Provider Identifier
1699116012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 28RI03384200
- Practice address
- 140 78TH St
D5
North Bergen, NJ 07047-5868 - Phone
- (215) 840-2592
- NPI assigned
- Jul 14, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 28RI03384200 | NJ | Primary |
Addresses
Primary practice location
140 78TH St
D5
North Bergen, NJ 07047-5868
Mailing address
140 78TH St
D5
North Bergen, NJ 07047-5868
Phone (215) 840-2592
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03384200 | NJ | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373760000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373760000000",
"number": "1699116012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 78TH ST",
"address_2": "D5",
"city": "NORTH BERGEN",
"state": "NJ",
"postal_code": "070475868",
"telephone_number": "215-840-2592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 78TH ST",
"address_2": "D5",
"city": "NORTH BERGEN",
"state": "NJ",
"postal_code": "070475868",
"telephone_number": "215-840-2592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVERON",
"first_name": "SAMUEL",
"middle_name": "LUIS",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-14",
"last_updated": "2013-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "NJ",
"license": "28RI03384200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Bergen, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.