Provider Demographics
NPI:1871505883
Name:KREPOSTMAN, JAIME I (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:I
Last Name:KREPOSTMAN
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 1:23 HACKETT BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3436
Mailing Address - Country:US
Mailing Address - Phone:518-463-4313
Mailing Address - Fax:518-463-3436
Practice Address - Street 1:23 HACKETT BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3436
Practice Address - Country:US
Practice Address - Phone:518-463-4313
Practice Address - Fax:518-463-3436
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125898174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM017934OtherAAO
NY17214OtherMVP
NY00507680Medicaid
NY10001108OtherCDPHP
NY125898OtherMD LICENSE
NY342911OtherEMPIRE BLUE CROSS
NYSE223481OtherWORKERS COMPENSATION
NYSE223481OtherWORKERS COMPENSATION
NY125898OtherMD LICENSE
NYB78005Medicare UPIN