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FRED REZVANI
NPI 1104887694
Specialist in Ridgewood, NJ

Active since April 01, 2006Opted out of Medicare · through Oct 4, 2027
119 PROSPECT ST, 1ST FLOOR SUITE 1, RIDGEWOOD, NJ 07450(201) 444-1600(201) 444-8774 Get Directions Write a Review

NPPES record last updated: May 6, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Fred Rezvani NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FRED REZVANI (NPI 1104887694) is an individual specialist in Ridgewood, New Jersey, licensed in New Jersey (25MA05115800) and active in the NPI registry since April 2006. He has opted out of Medicare through October 4, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1104887694
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameFRED REZVANI
Location Address119 PROSPECT ST, 1ST FLOOR SUITE 1Ridgewood, NJ 07450-4405
Mailing Address119 Prospect St, 1st Floor Suite 1Ridgewood, NJ 07450-4405 · (201) 444-1600 · Fax (201) 444-8774
Phone(201) 444-1600
Fax(201) 444-8774
Sole ProprietorNo
Enumeration DateApril 1, 2006
Last NPPES UpdateMay 6, 2025
NPPES CertifiedMay 6, 2025
✔ NPI 1104887694 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in NJ · 25MA05115800
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
119 PROSPECT ST, Ridgewood, NJ 07450
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Other Identifiers 6

Other30G161NJ · Empire Bc/bs Of Ny
Other4226530NJ · Aetna Ppo #
Other0K6927NJ · Healthnet #
OtherBP204NJ · Oxford Id#
Other0562861001NJ · Amerihealth #
Other0028398NJ · Aetna Hmo #

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Fred Rezvani has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 4, 2021 through October 4, 2027.

Opt-Out Effective DateOctober 4, 2021
Opt-Out In Effect ThroughOctober 4, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEALTHCARE 2000, LLC
Specialist
119 PROSPECT ST
RIDGEWOOD, NJ 07450
Bergen County (201) 444-1600
ZIA GHAVAMI M.D.
Pediatrics
119 PROSPECT ST
RIDGEWOOD, NJ 07450
Bergen County (201) 445-1212
PREMIER OBSTETRICS AND GYNECOLOGY OF RIDGEWOOD PC
Obstetrics & Gynecology
119 PROSPECT ST
RIDGEWOOD, NJ 07450
Bergen County (201) 639-3900
BROOKE S MOSSADED DDS
Dentist
119 PROSPECT ST
RIDGEWOOD, NJ 07450
Bergen County (201) 444-1600
COMPREHENSIVE PEDIATRIC CARE PC
Pediatrics
119 PROSPECT ST
RIDGEWOOD, NJ 07450
Bergen County (201) 445-1212
FRED REZVANI GYN LLC
Obstetrics & Gynecology
119 PROSPECT ST, 1ST FLOOR SUITE 1
RIDGEWOOD, NJ 07450
Bergen County (201) 444-1600
ELINA ZELDINA M.D.
Obstetrics & Gynecology
119 PROSPECT ST
RIDGEWOOD, NJ 07450
Bergen County (201) 639-3900
KATE LEVY
Nurse Practitioner (Women's Health)
119 PROSPECT ST
RIDGEWOOD, NJ 07450
Bergen County (201) 639-3900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fred Rezvani's NPI number?

The NPI number for Fred Rezvani is 1104887694. It was assigned to this individual provider in the NPPES registry on April 1, 2006.

Where is Fred Rezvani located?

Fred Rezvani practices at 119 Prospect St 1st Floor Suite 1, Ridgewood, NJ 07450. The listed phone number is (201) 444-1600.

What is Fred Rezvani's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Fred Rezvani enrolled in Medicare?

No. Fred Rezvani has opted out of Medicare through October 4, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Fred Rezvani was last updated on May 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.