Healthcare Provider Details

I. General information

NPI: 1366414799
Provider Name (Legal Business Name): DAVID GARY KREFETZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WHITE HORSE PIKE
CLEMENTON NJ
08021-4159
US

IV. Provider business mailing address

130 WHITE HORSE PIKE
CLEMENTON NJ
08021-4159
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-9000
  • Fax: 856-566-9701
Mailing address:
  • Phone: 856-566-9000
  • Fax: 856-566-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMB054684
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMB054684
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: