Basic Information
| Provider Information | |||||||||
| NPI: | 1588696728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRETAN | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | FAITH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 RARITAN COMMONS RTE 31 NORTH | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088221154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087825100 | ||||||||
| FaxNumber: | 9087820290 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 RARITAN COMMONS RTE 31 NORTH | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088221154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087825100 | ||||||||
| FaxNumber: | 9087820290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 25MA07861500 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207Q00000X | 25MA07861500 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 25MA07861500 | 01 | NJ | MEDICAL LICENSE | OTHER |