Individual
PIETER JAN KETELAAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1608 HIGHWAY 88, SUITE 208, BRICK, NJ 08724-3009
(732) 458-7878
(732) 840-6378
Mailing address
1608 HIGHWAY 88, SUITE 208, BRICK, NJ 08724-3009
(732) 458-7878
(732) 840-6378
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
25MA02713800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1815601
—
NJ
Enumeration date
01/12/2006
Last updated
10/13/2010
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