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Ms. Jennifer Alicea Revoredo, PA
Medical Physician Assistant in South Orange, New Jersey
NPI 1801239363

Jennifer Alicea Revoredo is a Medical Physician Assistant based in South Orange, NJ and is specialized in Medical. Jennifer Alicea Revoredo practices in South Orange, NJ and has the professional credentials of PA. The NPI Number for Jennifer Alicea Revoredo is 1801239363 and holds a License No. 25MP00304400 (New Jersey).

The current practice location address for Jennifer Alicea Revoredo is 20 Valley St Ste 320, South Orange, NJ and can be reached out via phone at 973-313-1113.

Location: 20 Valley St Ste 320, South Orange, NJ, 07079-2881
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1801239363
Provider Name
Jennifer Alicea Revoredo
Credential
PA
Provider Entity Type
Individual
Gender
Female
Address
20 Valley St Ste 320, South Orange, NJ, 07079-2881
Phone Number
973-313-1113
Fax Number
Provider Enumeration Date
04/15/2013
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
20 Valley St Ste 320
City
South Orange
State
New Jersey
Zip
07079-2881
Phone Number
973-313-1113
Fax Number
person
Provider Business Mailing Address Details
Address
20 Valley St Ste 320
City
South Orange
State
New Jersey
Zip
07079-2881
Phone Number
973-313-1113
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
25MP00304400 (New Jersey)
Definition
Definition to come...
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