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NPI Code Detail

MEDICARE: DR. DAVID GARY KREFETZ D.O.

MEDICARE: DR. DAVID GARY KREFETZ D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianMB054684NJ
22084P0804XChild & Adolescent Psychiatry PhysicianMB054684NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366414799
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID GARY KREFETZ D.O.
Provider Business Mailing Address
First Line : 130 WHITE HORSE PIKE
Second Line :
City : CLEMENTON
State : NJ
Zip : 08021-4159
Country : US
Telephone Number : 856-566-9000
Fax Number : 856-566-9701
Provider Business Practice Location Address
First Line : 130 WHITE HORSE PIKE
Second Line :
City : CLEMENTON
State : NJ
Zip : 08021-4159
Country : US
Telephone Number : 856-566-9000
Fax Number : 856-566-9701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 09/11/2025

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