Provider Demographics
NPI:1366414799
Name:KREFETZ, DAVID GARY (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GARY
Last Name:KREFETZ
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 1:130 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4159
Mailing Address - Country:US
Mailing Address - Phone:856-566-9000
Mailing Address - Fax:856-566-9701
Practice Address - Street 1:130 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4159
Practice Address - Country:US
Practice Address - Phone:856-566-9000
Practice Address - Fax:856-566-9701
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB0546842084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2218101Medicaid
NJ2218101Medicaid
NJ615731A0YMedicare ID - Type Unspecified