MS. JENNIFER ALICEA REVOREDO PA NPI 1801239363

NPI Information

NPI: 1801239363
Provider Name: MS. JENNIFER ALICEA REVOREDO, PA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
20 VALLEY ST STE 320
SOUTH ORANGE, NJ
ZIP 07079
Phone: (973) 313-1113
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MS. Jennifer Alicea Revoredo, PA is a medical physician assistant in South Orange, NJ. MS. Jennifer Alicea Revoredo, PA NPI is 1801239363. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

20 VALLEY ST STE 320
SOUTH ORANGE, NJ
ZIP 07079-881
Phone: (973) 313-1113

The NPI 1801239363 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/15/2013 and was last updated on 3/7/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	25MP00304400	NEW JERSEY	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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