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Contact Information

KETAREVIVE, INC
541 CEDAR HILL AVE
2ND FLOOR
WYCKOFF, NJ07481
 Phone: 201-212-6735
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
Indicates primary specialty

NPI Profile & details for KETAREVIVE, INC

NPI Number 1235977893
LBN Legal business name KETAREVIVE, INC
Authorized official JOSEPH AFFORTUNATO - (PARTNER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/17/2024
Last updated 03/18/2025 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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