Provider Demographics
NPI:1144208968
Name:SERETIS, GEORGE (DO)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SERETIS
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 1:499 BECKETT RD
Mailing Address - Street 2:SUITE 201-B
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1766
Mailing Address - Country:US
Mailing Address - Phone:856-467-6400
Mailing Address - Fax:856-467-1033
Practice Address - Street 1:499 BECKETT RD
Practice Address - Street 2:SUITE 201-B
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085
Practice Address - Country:US
Practice Address - Phone:856-467-6400
Practice Address - Fax:856-467-1033
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB65801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39916Medicare UPIN