Provider Demographics
NPI:1255476008
Name:HECTOR RETIK MD PC
Entity Type:Organization
Organization Name:HECTOR RETIK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PC
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RETIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-968-6655
Mailing Address - Street 1:984 NORTH BROADWAY
Mailing Address - Street 2:SUITE #507
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1308
Mailing Address - Country:US
Mailing Address - Phone:914-968-6655
Mailing Address - Fax:914-968-3366
Practice Address - Street 1:984 NORTH BROADWAY
Practice Address - Street 2:SUITE #507
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1308
Practice Address - Country:US
Practice Address - Phone:914-968-6655
Practice Address - Fax:914-968-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1000412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00171311Medicaid
NY00171311Medicaid