Phyllis Vretenicic, MD

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

387820031 Issued in NY

Practice address

527 Pearl St
Oceanside, NY 11572-1934

Phone

(516) 581-0960

NPI assigned

Aug 12, 2014

Last updated

Aug 12, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Phyllis Gennaro Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407801600000",
    "number": "1326457573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 PEARL ST",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115721934",
            "telephone_number": "516-581-0960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 PEARL ST",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115721934",
            "telephone_number": "516-581-0960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VRETENICIC",
        "first_name": "PHYLLIS",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-12",
        "last_updated": "2014-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NY",
            "license": "387820031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PHYLLIS",
            "last_name": "GENNARO",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Behavior Analyst in Oceanside, NY
• Providers in Oceanside, NY by specialty
• Behavior Analyst in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.