Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 192911-1 | NY |
Y | 208600000X | Surgeon | 192911-1 | NY |
N | 208200000X | Surgeon | MD044340E | PA |
N | 208600000X | Surgeon | MD044340E | PA |
NPI | 1003880683 |
---|---|
Provider Name | Dr. Matthew Kelsey Reppert |
First Address | Painted Post, NY 14870-9339 |
Second Address | Painted Post, NY 14870-9339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 09/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014394690003 | (05) | PA |
01431621 | (05) | NY |
020049791 | RR MEDICARE PIN (01) | NY |
CC8362 | RR MEDICARE GROUP (01) | NY |
F64037 | (02) |