Basic Information
| Provider Information | |||||||||
| NPI: | 1851384283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LORETI | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 784 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074171306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8447770910 | ||||||||
| FaxNumber: | 2015600712 | ||||||||
| Practice Location | |||||||||
| Address1: | 784 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8447770910 | ||||||||
| FaxNumber: | 2015600712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 12/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA06144600 | NJ | N | Other Service Providers | Specialist | 207RS0010X | 25MA06144600 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0K4428 | 01 | NJ | HEALTHNET # | OTHER | P461978 | 01 | NJ | OXFORD # | OTHER | 5U8681 | 01 | NJ | EMPIRE BC/BS NY # | OTHER | 200034632 | 01 | NJ | RR MDCR # | OTHER |