Provider Demographics
NPI:1205531688
Name:ELITE PREMIER MEDICAL CARE PLUS LLC.
Entity type:Organization
Organization Name:ELITE PREMIER MEDICAL CARE PLUS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:REVOREDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-509-3903
Mailing Address - Street 1:15-01 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6003
Mailing Address - Country:US
Mailing Address - Phone:201-773-4200
Mailing Address - Fax:
Practice Address - Street 1:15-01 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6003
Practice Address - Country:US
Practice Address - Phone:201-773-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty