Provider Demographics
NPI:1497411938
Name:REVITALIZING REMEDIES LLC
Entity Type:Organization
Organization Name:REVITALIZING REMEDIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:FIORELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADISI
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:201-727-3241
Mailing Address - Street 1:52 NEWTON SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2723
Mailing Address - Country:US
Mailing Address - Phone:201-727-3241
Mailing Address - Fax:201-727-3241
Practice Address - Street 1:52 NEWTON SPARTA RD STE 1
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07860-2723
Practice Address - Country:US
Practice Address - Phone:201-727-3241
Practice Address - Fax:201-727-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty