Provider Demographics
NPI:1740269000
Name:KARETNICK, GERALD DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DAVID
Last Name:KARETNICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3093
Mailing Address - Country:US
Mailing Address - Phone:845-623-2456
Mailing Address - Fax:845-623-6420
Practice Address - Street 1:36 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3093
Practice Address - Country:US
Practice Address - Phone:845-623-2456
Practice Address - Fax:845-623-6420
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI15453Medicare UPIN
NJ082754VF3Medicare ID - Type Unspecified