Gary John Petenko, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DIO1093200 Issued in NJ

Practice address

3 Palomino Way
Marlboro, NJ 07746-1948

Phone

(732) 462-7072

Fax

(732) 294-7714

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269993600000",
    "number": "1205924149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 PALOMINO WAY",
            "city": "MARLBORO",
            "state": "NJ",
            "postal_code": "077461948",
            "telephone_number": "732-462-1063",
            "fax_number": "732-294-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 PALOMINO WAY",
            "city": "MARLBORO",
            "state": "NJ",
            "postal_code": "077461948",
            "telephone_number": "732-462-7072",
            "fax_number": "732-294-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETENKO",
        "first_name": "GARY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2010-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "DIO1093200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dipti Patel, PT, DPT
• Jayendra N. Patel, M.D., F.A.C.C.
• Sonali Girish Patel, PHARMD
• Sabine T Paul-Yee, MD
• Robert Persico, DPT
• Pharmacy Emporium LLC
• John Robert Pilarte, P.T., D.P.T.
• Pink Jelly Paramedical Services, LLC
• Lauren Pinkus, DMD, MS
• Anisha Pittman, APN-C

• General Practice Dentistry in Marlboro, NJ
• Providers in Marlboro, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.