Provider Demographics
NPI:1811184211
Name:KRETOV, ALEKSEY (MD)
Entity type:Individual
Prefix:DR
First Name:ALEKSEY
Middle Name:
Last Name:KRETOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 ROUTE 35
Mailing Address - Street 2:STE 105
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-2766
Mailing Address - Country:US
Mailing Address - Phone:732-414-2005
Mailing Address - Fax:732-414-2006
Practice Address - Street 1:1806 ROUTE 35
Practice Address - Street 2:STE 105
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2766
Practice Address - Country:US
Practice Address - Phone:732-414-2005
Practice Address - Fax:732-414-2006
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08294000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine