Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Fred Rezvani

Individual provider Specialist · NPI 1104887694

Fred Rezvani is a Specialist in Ridgewood, New Jersey. Licensed in New Jersey. Registered with an NPI since 2006.

Licensed in
NJ
In the registry since
2006

Practice location Address checks out

119 Prospect St 1st Fl Ste 1
Ridgewood, NJ 07450-4405
Phone: (201) 444-1600
Fax: (201) 444-8774
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 25MA05115800 (NJ)

Record details

NPI number1104887694
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 1, 2006
Last updated in NPPESMay 6, 2025
Certification dateMay 6, 2025
Mailing address119 Prospect St, 1st Floor Suite 1, Ridgewood, NJ 07450-4405

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