Individual
DR. JOHN S ETTENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 THEALL RD, RYE, NY 10580-1404
(914) 848-8800
(914) 682-6403
Mailing address
210 WESTCHESTER AVE, WHITE PLAINS, NY 10604-2901
(914) 681-3146
(914) 682-6403
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
041999
CT
207W00000X
Ophthalmology Physician
Primary
174308-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01072893
—
NY
01
—
133757245
CIGNA
NY
01
—
21E601
EMPIRE BCBS
NY
Enumeration date
03/16/2006
Last updated
10/16/2013
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