Healthcare Provider Details

I. General information

NPI: 1447946181
Provider Name (Legal Business Name): ROBERT DEPEPPO STUDENT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 20TH ST NW
WASHINGTON DC
20036-3406
US

IV. Provider business mailing address

371 BRYSON AVE
STATEN ISLAND NY
10314-1924
US

V. Phone/Fax

Practice location:
  • Phone: 202-416-2000
  • Fax:
Mailing address:
  • Phone: 347-552-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: