Provider Demographics
NPI:1750632725
Name:REPAK, ANDREW JOHN
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOHN
Last Name:REPAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 UNION AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1962
Mailing Address - Country:US
Mailing Address - Phone:732-667-5000
Mailing Address - Fax:
Practice Address - Street 1:495 UNION AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1962
Practice Address - Country:US
Practice Address - Phone:732-667-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-30
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor