Basic Information
Provider Information
NPI: 1124063532
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KRETTEK
FirstName: JANET
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1650 HUNTINGDON PIKE
Address2: SUITE 205
City: MEADOWBROOK
State: PA
PostalCode: 190468004
CountryCode: US
TelephoneNumber: 2159383145
FaxNumber: 2159383144
Practice Location
Address1: 1650 HUNTINGDON PIKE
Address2: SUITE 205
City: MEADOWBROOK
State: PA
PostalCode: 190468004
CountryCode: US
TelephoneNumber: 2159383145
FaxNumber: 2159383144
Other Information
ProviderEnumerationDate: 06/19/2006
LastUpdateDate: 10/27/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XOS015427PAY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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