Individual
DR. GERALD DETATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 S WHITE HORSE PIKE, HAMMONTON, NJ 08037-1804
(609) 567-2573
(609) 561-8046
Mailing address
8 BRIDLEWOOD CT, TABERNACLE, NJ 08088-9600
(609) 792-1092
(609) 388-4373
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA04005400
NJ
Other
Enumeration date
01/27/2006
Last updated
04/27/2016
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