Provider Demographics
NPI:1619054509
Name:KREPS, EDWARD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:KREPS
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 1:10 DEERLAND ACRES
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-4316
Mailing Address - Country:US
Mailing Address - Phone:845-265-2708
Mailing Address - Fax:
Practice Address - Street 1:10 DEERLAND ACRES
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516-4316
Practice Address - Country:US
Practice Address - Phone:845-265-2708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112872207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00419594Medicaid
NY00419594Medicaid
NY507151Medicare ID - Type Unspecified