Provider Demographics
NPI:1972686079
Name:LEPIS, MICHAEL ALPHONSE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALPHONSE
Last Name:LEPIS
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 1:2420 HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-223-2873
Mailing Address - Fax:732-223-5726
Practice Address - Street 1:2420 HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-223-2873
Practice Address - Fax:732-223-5726
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07363300208100000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
192671OtherAMERIGROUP
2253382000OtherAMERIHEALTH
NJ8830908Medicaid
4358367OtherCIGNA
73Z641OtherWELLCHOICES
043675325OtherQUALCARE
2K3128OtherHEALTHNET
043675925OtherBLUE CROSS BLUE SHIELD
043675325OtherUNITED HEALTHCARE
P2728923OtherOXFORD
3120203OtherAETNA
2K3128OtherHEALTHNET
043675925OtherBLUE CROSS BLUE SHIELD