Provider Demographics
NPI:1851385074
Name:MORETZ, J ALFRED III (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:ALFRED
Last Name:MORETZ
Suffix:III
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 1:1729 BURRSTONE RD.
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413
Mailing Address - Country:US
Mailing Address - Phone:315-798-1431
Mailing Address - Fax:315-798-1444
Practice Address - Street 1:1729 BURRSTONE RD.
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-798-1431
Practice Address - Fax:315-798-1444
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214285207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01959008Medicaid
NY01959008Medicaid
RA0938Medicare ID - Type Unspecified