Provider Demographics
NPI:1982697223
Name:REPPUCCI, ANGELO D (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:D
Last Name:REPPUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NORTHERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5200
Mailing Address - Country:US
Mailing Address - Phone:516-482-3223
Mailing Address - Fax:516-482-2533
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5200
Practice Address - Country:US
Practice Address - Phone:516-482-3223
Practice Address - Fax:516-482-2533
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01590629Medicaid
NYF34550Medicare UPIN
NY03193HMedicare PIN
NY68H681Medicare PIN