Healthcare Provider Details

I. General information

NPI: 1457471799
Provider Name (Legal Business Name): APARNA REPAKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROBERT WOOD JOHNSON PL MEB 478
NEW BRUNSWICK NJ
08901-1928
US

IV. Provider business mailing address

39 GINGER DR
EDISON NJ
08837-3081
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6105
  • Fax:
Mailing address:
  • Phone: 732-235-6105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301088662
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number094863
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA08993800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: