Healthcare Provider Details

I. General information

NPI: 1093386013
Provider Name (Legal Business Name): SHANE J REPMANN MED, LPC, BCN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 VALLEY RD STE 1B
STIRLING NJ
07980-1346
US

IV. Provider business mailing address

1390 VALLEY RD STE 1B
STIRLING NJ
07980-1346
US

V. Phone/Fax

Practice location:
  • Phone: 908-848-3872
  • Fax:
Mailing address:
  • Phone: 908-992-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00974600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: