Healthcare Provider Details

I. General information

NPI: 1235188798
Provider Name (Legal Business Name): STEPHEN H URETSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 NEW ROAD STE 6
LINWOOD NJ
08221
US

IV. Provider business mailing address

2021 NEW ROAD STE 6
LINWOOD NJ
08221
US

V. Phone/Fax

Practice location:
  • Phone: 609-927-3373
  • Fax: 609-927-4041
Mailing address:
  • Phone: 609-927-3373
  • Fax: 609-927-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA42134
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: