| Elite Premier Medical Care Plus Llc. | |
|
15-01 Broadway Fair Lawn NJ 07410-6003 | |
| (201) 773-4200 | |
| Not Available |
| Full Name | Elite Premier Medical Care Plus Llc. |
|---|---|
| Speciality | Family Medicine |
| Location | 15-01 Broadway, Fair Lawn, New Jersey |
| Authorized Official Name and Position | Fred Revoredo (MD) |
| Authorized Official Contact | 2015093903 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Premier Medical Care Plus Llc. 15-01 Broadway Fair Lawn NJ 07410-6003 Ph: (201) 773-4200 | Elite Premier Medical Care Plus Llc. 15-01 Broadway Fair Lawn NJ 07410-6003 Ph: (201) 773-4200 |
| NPI Number | 1205531688 |
|---|---|
| Provider Enumeration Date | 04/04/2023 |
| Last Update Date | 07/29/2024 |
| Medicare PECOS PAC ID | 4981067964 |
|---|---|
| Medicare Enrollment ID | O20230823002475 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205531688 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Fred S Revoredo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669588422 PECOS PAC ID: 3779479480 Enrollment ID: I20040227000314 |
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