Provider Demographics
NPI:1417979717
Name:KORETSKY, STEPHEN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:KORETSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 FIREMENS MEMORIAL DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3553
Mailing Address - Country:US
Mailing Address - Phone:845-354-8643
Mailing Address - Fax:845-746-9083
Practice Address - Street 1:26 FIREMENS MEMORIAL DR
Practice Address - Street 2:SUITE 113
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3553
Practice Address - Country:US
Practice Address - Phone:845-354-8643
Practice Address - Fax:845-746-9083
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009372103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV53361Medicare PIN