Provider Demographics
NPI:1619902046
Name:REPOLE, ADAM N (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:N
Last Name:REPOLE
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 1:475 ROUTE 70
Mailing Address - Street 2:SUITE 101 OCEAN GYN & OB ASSOCIATES
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-364-8000
Mailing Address - Fax:732-364-4601
Practice Address - Street 1:475 ROUTE # 70
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-364-8000
Practice Address - Fax:732-364-4601
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06092000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6243509Medicaid
F98286Medicare UPIN
NJ6243509Medicaid