Provider Demographics
NPI:1134183460
Name:CETTA, PETER JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:CETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 W HANOVER AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:973-895-4600
Mailing Address - Fax:973-895-4604
Practice Address - Street 1:10 W HANOVER AVE
Practice Address - Street 2:STE 103
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-895-4600
Practice Address - Fax:973-895-4604
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36318207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0951265OtherCIGNA HEALTHCARE
1323553OtherIL AZ FIRST HEALTH
PA895564OtherAMERIHEALTH PPO
222302679OtherGEHA
NY010036318NJ01OtherANTHEM HEALTH
052811440OtherRR MEDICARE
NJ0076931000OtherAMERIHEALTH HMO POS
1323553OtherMAIL HANDLERS BENEFIT PLA
IS269OtherOXFORD
0K0704OtherHEALTH NET OF THE NORTHEA
NY9537062OtherGHI
ILS46801OtherAMERICAN IMAGING MGMT
0038164OtherAETNA
NJ13254OtherOPERATING ENGINEERS OF LO
NY53A861OtherWELL CHOICE
447459OtherUNITED HEALTHCARE
NY9537062OtherMULTIPLAN
1323553OtherMAIL HANDLERS BENEFIT PLA
447459OtherUNITED HEALTHCARE
NJ0839480001Medicare NSC