Provider Demographics
NPI:1396724001
Name:REPAGE, PAUL P (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:P
Last Name:REPAGE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CHANDLER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2827
Mailing Address - Country:US
Mailing Address - Phone:646-468-5522
Mailing Address - Fax:
Practice Address - Street 1:100 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2112
Practice Address - Country:US
Practice Address - Phone:908-233-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV6107-1152W00000X
NJ27OA00565200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ044155Medicare ID - Type Unspecified
NJU78721Medicare UPIN