Provider Demographics
NPI:1124341110
Name:MONROE KARETZKY, MD, P.A.
Entity type:Organization
Organization Name:MONROE KARETZKY, MD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONROE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARETZKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-569-0404
Mailing Address - Street 1:200 ENGLE ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2440
Mailing Address - Country:US
Mailing Address - Phone:201-596-0404
Mailing Address - Fax:201-569-0422
Practice Address - Street 1:200 ENGLE ST
Practice Address - Street 2:SUITE 10
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2440
Practice Address - Country:US
Practice Address - Phone:201-596-0404
Practice Address - Fax:201-569-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02871700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3037606Medicaid
NJ3037606Medicaid
NJC52548Medicare UPIN