Provider Demographics
NPI:1457314080
Name:ARETSKY, PHILIP JOEL (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOEL
Last Name:ARETSKY
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 1:345 ROUTE 17 STE 7
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2307
Mailing Address - Country:US
Mailing Address - Phone:201-447-1055
Mailing Address - Fax:201-447-4974
Practice Address - Street 1:345 ROUTE 17 STE 7
Practice Address - Street 2:
Practice Address - City:UPPER SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-2307
Practice Address - Country:US
Practice Address - Phone:201-447-1055
Practice Address - Fax:201-447-4974
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02359300207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C52899Medicare UPIN
066848Medicare ID - Type Unspecified