Provider Demographics
NPI:1609021922
Name:GETTENBERG, ERICA KASS (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:KASS
Last Name:GETTENBERG
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 1:14 OLD SMITH RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2227
Mailing Address - Country:US
Mailing Address - Phone:917-576-5541
Mailing Address - Fax:929-450-4899
Practice Address - Street 1:220 5TH AVE FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-8017
Practice Address - Country:US
Practice Address - Phone:212-564-0480
Practice Address - Fax:833-907-2300
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA104684002084P0800X
NY2652592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12679951Medicaid