Healthcare Provider Details

I. General information

NPI: 1205706702
Provider Name (Legal Business Name): REPERIO HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 W PALISADE AVE STE 2B
ENGLEWOOD NJ
07631-2706
US

IV. Provider business mailing address

4784 SE 17TH AVE STE 125
PORTLAND OR
97202-4715
US

V. Phone/Fax

Practice location:
  • Phone: 844-504-0402
  • Fax: 503-296-5806
Mailing address:
  • Phone: 844-504-0402
  • Fax: 503-296-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEX MARSH
Title or Position: MANAGING OWNER
Credential: MD
Phone: 503-931-1114