Provider Demographics
NPI:1457669004
Name:KREPKIN, KONSTANTIN (MD)
Entity Type:Individual
Prefix:
First Name:KONSTANTIN
Middle Name:
Last Name:KREPKIN
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 1:777 PASSAIC AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1804
Mailing Address - Country:US
Mailing Address - Phone:973-284-0020
Mailing Address - Fax:
Practice Address - Street 1:20 HIGH ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1132
Practice Address - Country:US
Practice Address - Phone:973-284-0020
Practice Address - Fax:973-284-6310
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA098374002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology