Healthcare Provider Details

I. General information

NPI: 1497346233
Provider Name (Legal Business Name): ERIKA REPOLI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BANTA PL
HACKENSACK NJ
07601-5612
US

IV. Provider business mailing address

111 ELM AVE
FAIRVIEW NJ
07022-1004
US

V. Phone/Fax

Practice location:
  • Phone: 201-205-1131
  • Fax:
Mailing address:
  • Phone: 201-294-9684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: