Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F308343 | NY |
NPI | 1023332848 |
---|---|
Provider Name | German Restrepo |
First Address | Middletown, NY 10940-6132 |
Second Address | New Windsor, NY 12553-7612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2010 |
Last Update Date | 26/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05027761 | (05) | NY |
F308343 | ANP LICENSE (01) | NY |