Provider Demographics
NPI:1457463507
Name:FETTO, JOSEPH F (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:FETTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 1ST AVE
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-7296
Mailing Address - Fax:212-263-6199
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:SUITE 5B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-7296
Practice Address - Fax:212-263-6199
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY124320207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06A941Medicare PIN
NYA60199Medicare UPIN