Healthcare Provider Details

I. General information

NPI: 1689767394
Provider Name (Legal Business Name): MERLA ROSAL REPATO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80TH ST & 41ST AVE
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

79-01 BROADWAY D1-01
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-5970
  • Fax: 718-334-5958
Mailing address:
  • Phone: 718-334-1920
  • Fax: 718-334-5958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: