Healthcare Provider Details

I. General information

NPI: 1821173469
Provider Name (Legal Business Name): MICHAEL MARTIN REPICE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E MAIN ST
HUNTINGTON NY
11743-2812
US

IV. Provider business mailing address

5 E MAIN ST
HUNTINGTON NY
11743-2812
US

V. Phone/Fax

Practice location:
  • Phone: 631-271-1640
  • Fax: 631-271-0776
Mailing address:
  • Phone: 631-271-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number138115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: