Provider Demographics
NPI:1063524536
Name:RETTAGLIATA, GEORGE J (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:RETTAGLIATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 RALPH PL
Mailing Address - Street 2:STE 308
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4416
Mailing Address - Country:US
Mailing Address - Phone:718-442-2882
Mailing Address - Fax:718-442-2885
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:STE 308
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4416
Practice Address - Country:US
Practice Address - Phone:718-442-2882
Practice Address - Fax:718-442-2885
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY178978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E49787Medicare UPIN