NPIMap

Organization Active NPI

Revoredo Medical Affiliates LLC

  • Family Medicine Physician
  • Paterson, NJ
National Provider Identifier
1881927358
Registry record updated Sep 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MA07147400 Issued in NJ
Legal business name
REVOREDO MEDICAL AFFILIATES LLC
Practice address
425 15TH Ave
Paterson, NJ 07504-1811
Phone
(973) 345-4024
Fax
(973) 345-4156
NPI assigned
Sep 15, 2009
Last updated
Sep 15, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2009

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

Authorized official

Name
Dr. Fred S Revoredo, MDNPI 1669588422
Title
President
Phone
(973) 345-4024

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X 25MA07147400 NJ
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 25MA07147400 NJ Primary

Addresses

Primary practice location

425 15TH Ave
Paterson, NJ 07504-1811

Mailing address

425 15TH Ave
Paterson, NJ 07504-1811
Phone (973) 345-4024

National Provider Directory

National Provider Directory

Locations

425 15th Ave
Paterson, NJ 07504
Phone (973) 345-4024

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1252972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252972800000",
    "number": "1881927358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 15TH AVE",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075041811",
            "telephone_number": "973-345-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 15TH AVE",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075041811",
            "telephone_number": "973-345-4024",
            "fax_number": "973-345-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOREDO MEDICAL AFFILIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-15",
        "last_updated": "2009-09-15",
        "status": "A",
        "authorized_official_last_name": "REVOREDO",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-345-4024",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MA07147400",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA07147400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paterson, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; 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.