1871505883 NPI number — JAIME I KREPOSTMAN M.D.

Table of content: JAIME I KREPOSTMAN M.D. (NPI 1871505883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871505883 NPI number — JAIME I KREPOSTMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREPOSTMAN
Provider First Name:
JAIME
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871505883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 HACKETT BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12208-3436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-463-4313
Provider Business Mailing Address Fax Number:
518-463-3436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 HACKETT BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12208-3436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-463-4313
Provider Business Practice Location Address Fax Number:
518-463-3436
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  125898 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017934 . This is a "AAO" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 17214 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00507680 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10001108 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 125898 . This is a "MD LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 342911 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: SE223481 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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