Provider Demographics
NPI:1154330231
Name:DEKRET, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:DEKRET
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 1:1503 LANSDOWNE AVE
Mailing Address - Street 2:SUITE 3005
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1330
Mailing Address - Country:US
Mailing Address - Phone:610-524-1552
Mailing Address - Fax:
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:SUITE 3005
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-524-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015541E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007491350006Medicaid
PA0046415000OtherPERSONAL CHOICE
PAB35427Medicare UPIN
PA0007491350006Medicaid