Healthcare Provider Details

I. General information

NPI: 1497411938
Provider Name (Legal Business Name): REVITALIZING REMEDIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 NEWTON SPARTA RD STE 1
ANDOVER NJ
07860-2723
US

IV. Provider business mailing address

52 NEWTON SPARTA RD
NEWTON NJ
07860-2723
US

V. Phone/Fax

Practice location:
  • Phone: 201-727-3241
  • Fax: 201-727-3241
Mailing address:
  • Phone: 201-727-3241
  • Fax: 201-727-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FIORELLA PARADISI
Title or Position: OWNER/CLINICIAN PROVIDER
Credential: APN
Phone: 201-727-3241