PETER A KORETSKY MD PA (NPI# 1124117791) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124117791 |
| Entity Type | Organization |
| Organization Name | PETER A KORETSKY MD PA |
| Practice Address |
2955 Pineda Plaza Way Ste 115 Melbourne FL 32940-7306 |
| Practice Telephone | 3212547375 |
| Practice Fax Number | 3212547145 |
| Mailing Telephone | 3212547375 |
| Mailing Fax Number | 3212547145 |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2014-03-28 |
| Authorized Official Name | MR. PETER A KORETSKY (PRESIDENT) |
| Authorized Official Telephone | 3212547375 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 2734737 | 05 |
| Street Address |
2955 PINEDA PLAZA WAY STE 115 |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32940-7306 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467556456 | Peter A Koretsky | Internal Medicine | 2955 Pineda Plaza Way Ste 115, Melbourne, FL 32940-7306 | 2006-09-11 |
| 1891096731 | Mary Lou Koretsky | Nurse Practitioner | 2955 Pineda Plaza Way Ste 115, Melbourne, FL 32940-7306 | 2010-11-09 |
| 1861550964 | Jill Larue Polet | Nurse Practitioner | 2955 Pineda Plaza Way Ste 115, Melbourne, FL 32940-7306 | 2006-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700403649 | True Motion Physical Therapy and Wellness | Clinic/Center | 3536 Peninsula Circle, Mlebourne, FL 32940 | 2020-06-26 |
| 1568089431 | Live Gracefully Physio and Wellness, Pllc | Clinic/Center | 6470 Shadow Creek Trail, Apt 5204, Melbourne, FL 32940 | 2020-06-26 |
| 1295360592 | Hiteshi Patel | Pharmacist | 3134 Hummingbird Way, Melbourne, FL 32940 | 2020-03-06 |
| 1972133122 | Curtis Lynn Curbo | Social Worker | 3830 Fringetree Lane, Melbourne, FL 32940 | 2020-01-16 |
| 1861038283 | Medfast Urgent Care Centers, LLC | Clinic/Center | 5500 Stadium Parkway, Melbourne, FL 32940 | 2019-11-20 |
| 1134601594 | Caroline Grace Bennett | Behavior Technician | 5500 Murrell Rd Suite 100, Melbourne, FL 32940 | 2018-09-02 |
| 1730682642 | Centennial Medical Group | Family Medicine | 1341 Bedford Drive, Melbourne, FL 32940 | 2018-03-16 |
| 1356849251 | Executive Non-emergency Transportation, Inc. | Non-emergency Medical Transport (VAN) | 3155-02 Suntree Blvd, Melbourne, FL 32940 | 2018-01-25 |
| 1679081160 | Brevard Oaks Center, LLC | Skilled Nursing Facility | 2355 Vidina Drive, Viera, FL 32940 | 2018-01-18 |
| 1275045817 | Comfortable Care Dental Health Professionals. P.a. | Dentist | 6340 N Wickham Rd Ste 101, Melbourne, FL 32940 | 2017-11-03 |
| Find all providers in zip 32940 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700983863 | Shireen F Gadallah | Internal Medicine | 25 Silver Palm Ave, Suite B, Melbourne, FL 32901-3177 | 2006-09-20 |
| 1467556456 | Peter A Koretsky | Internal Medicine | 2955 Pineda Plaza Way Ste 115, Melbourne, FL 32940-7306 | 2006-09-11 |
| 1275519548 | Scott Seminer | Internal Medicine | 1334 Valentine St, Melbourne, FL 32901-3128 | 2005-12-19 |
| 1164406500 | Jeremiah Paul Donovan | Internal Medicine | 6235 Anello Dr, Melbourne, FL 32940 | 2005-11-30 |
| 1922081983 | Athan P Kartsonis | Internal Medicine | 1301 Hickory St, Melbourne, FL 32901-3223 | 2005-11-23 |
| 1861483810 | Glenn David Gardner | Internal Medicine | 1324 Valentine St, Melbourne, FL 32901-3128 | 2005-10-31 |
| 1316937535 | Kaseng Derek Chan-pong | Internal Medicine | 1223 Gateway Dr Ste B, Melbourne, FL 32901-2607 | 2005-10-27 |
| 1114917655 | Charles A Farrington | Internal Medicine | 1223 Gateway Dr Ste 2b, Melbourne, FL 32901-2607 | 2005-10-26 |
| 1700870847 | Mark Douglas Hughes | Internal Medicine | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2005-09-06 |
| 1033101985 | Martin E Avalos | Internal Medicine | 8725 N Wickham Rd, Suite 302, Melbourne, FL 32940-5997 | 2005-08-17 |
| Find all providers in MELBOURNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.