Healthcare Provider Details

I. General information

NPI: 1790044105
Provider Name (Legal Business Name): KARA REPICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 IRVING AVE SUITE 108
SYRACUSE NY
13210-1756
US

IV. Provider business mailing address

338 CAMECO CIR
LIVERPOOL NY
13090-2735
US

V. Phone/Fax

Practice location:
  • Phone: 315-671-0070
  • Fax:
Mailing address:
  • Phone: 585-749-4894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number285623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: