Provider Demographics
NPI:1538262787
Name:ZARETSKY, ALAN MARK (MSW, DMD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:MARK
Last Name:ZARETSKY
Suffix:
Gender:M
Credentials:MSW, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 JANE STREET
Mailing Address - Street 2:APT 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:212-727-3974
Mailing Address - Fax:212-799-1359
Practice Address - Street 1:61 JANE STREET
Practice Address - Street 2:APT 4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014
Practice Address - Country:US
Practice Address - Phone:212-727-3974
Practice Address - Fax:212-799-1359
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04312911041C0700X
NJ44SC006761001041C0700X
NY032976-11223G0001X
NJ22DI011343001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP398263OtherOXFORD
NYP398263OtherOXFORD