Provider Demographics
NPI:1700012929
Name:R B JETTER ,MD, PC
Entity Type:Organization
Organization Name:R B JETTER ,MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:JETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-517-5200
Mailing Address - Street 1:737 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4256
Mailing Address - Country:US
Mailing Address - Phone:212-517-5200
Mailing Address - Fax:212-737-5657
Practice Address - Street 1:737 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4256
Practice Address - Country:US
Practice Address - Phone:212-517-5200
Practice Address - Fax:212-737-5657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143209174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty