Healthcare Provider Details

I. General information

NPI: 1235377326
Provider Name (Legal Business Name): GIORGIO E REPETI L AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W 72ND ST RM 2F
NEW YORK NY
10023-3278
US

IV. Provider business mailing address

125 W 72ND ST RM 2F
NEW YORK NY
10023-3278
US

V. Phone/Fax

Practice location:
  • Phone: 212-721-8183
  • Fax: 212-721-8183
Mailing address:
  • Phone: 212-721-8183
  • Fax: 212-721-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003174
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: