Healthcare Provider Details

I. General information

NPI: 1841008455
Provider Name (Legal Business Name): MATTEO REPETTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2024
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E 74TH ST
NEW YORK NY
10021-3459
US

IV. Provider business mailing address

475 MAIN ST APT 7A
NEW YORK NY
10044-0089
US

V. Phone/Fax

Practice location:
  • Phone: 917-753-2647
  • Fax:
Mailing address:
  • Phone: 917-753-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: