Provider Demographics
NPI:1942271283
Name:KORETZKY, JEFFREY ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:KORETZKY
Suffix:
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 1:1180 SHEPERD COURT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-244-3605
Mailing Address - Fax:
Practice Address - Street 1:4618 ROUTE 9 SOUTH
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731
Practice Address - Country:US
Practice Address - Phone:732-364-5533
Practice Address - Fax:732-367-1325
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06614600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7421702Medicaid
G60682Medicare UPIN
NJ7421702Medicaid