Provider Demographics
NPI:1508806951
Name:GETTYS, JACQUELINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:GETTYS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 PARKWAY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3018
Mailing Address - Country:US
Mailing Address - Phone:609-883-5454
Mailing Address - Fax:609-883-2565
Practice Address - Street 1:1230 PARKWAY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3018
Practice Address - Country:US
Practice Address - Phone:609-883-5454
Practice Address - Fax:609-883-2565
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04930300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2293706Medicaid
NJ456865Medicare PIN
NJD19087Medicare UPIN
NJ2293706Medicaid