Provider Demographics
NPI:1336780113
Name:REPOLE, MICHELLE SHULMAN (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SHULMAN
Last Name:REPOLE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:SHULMAN
Other - Last Name:REPOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:150 NEW PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2590
Mailing Address - Country:US
Mailing Address - Phone:908-233-3720
Mailing Address - Fax:908-389-5675
Practice Address - Street 1:7 EAST DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6840
Practice Address - Country:US
Practice Address - Phone:732-890-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00965700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics