Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X004193 | NY |
NPI | 1417057357 |
---|---|
Provider Name | Dr. Diane J. Reppert |
First Address | New York, NY 10019-2302 |
Second Address | New York, NY 10019-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 02/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U29063 | (02) | NY |