Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 25MB10917600 | NJ |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 299096 | NY |
NPI | 1700249547 |
---|---|
Provider Name | Dr. Paola Reveco |
First Address | Flushing, NY 11355-5045 |
Second Address | Berkeley Heights, NJ 07922-2104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 09/02/2021 |