Provider Demographics
NPI:1417057357
Name:REPPERT, DIANE J (DC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:J
Last Name:REPPERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 57TH ST STE 712
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2302
Mailing Address - Country:US
Mailing Address - Phone:212-581-9079
Mailing Address - Fax:212-581-1413
Practice Address - Street 1:119 W 57TH ST STE 712
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2302
Practice Address - Country:US
Practice Address - Phone:212-581-9079
Practice Address - Fax:212-581-1413
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004193111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU29063Medicare UPIN
NY53318BMedicare PIN