Marjorie Ketzak, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2200SG Issued in NY

Practice address

4207 State Highway 220
Oxford, NY 13830-4305

Phone

(607) 843-3140

Fax

(607) 843-3162

NPI assigned

Jul 28, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mketzak1@hiemail.healtheconnections.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• State of New York Comptrollers Office

  • Skilled Nursing Facility
  • Oxford, NY
  • NPI 1386851004
  Medicare reassignment NPD
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Staten Island, NY
  • NPI 1750469912
  NPD

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606435200000",
    "number": "1780684159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4207 STATE HIGHWAY 220",
            "city": "OXFORD",
            "state": "NY",
            "postal_code": "138304305",
            "telephone_number": "607-843-3140",
            "fax_number": "607-843-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4207 STATE HIGHWAY 220",
            "city": "OXFORD",
            "state": "NY",
            "postal_code": "138304305",
            "telephone_number": "607-843-3140",
            "fax_number": "607-843-3162"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29 N Chenango St",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Greene",
            "state": "NY",
            "postal_code": "137781154",
            "country_code": "US",
            "telephone_number": "607-875-4334",
            "fax_number": "888-603-9093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETZAK",
        "first_name": "MARJORIE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-28",
        "last_updated": "2020-11-27",
        "certification_date": "2020-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "2200SG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02154465",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Wallace Donegan, RN
• Heather L. Ferrarese, RPH., PHARM. D.
• Golden Girls Homecare
• Joseph R Hauptfleisch, PT
• Cathie L. Heggie, OTR/L
• Mary Lamonica, OTR/L
• Valeda Macdonald
• Gail Ann Mathieson-Devereaux, FNP
• Renee Janet Maynard, RN
• Terri Lynne Maynard, LPN

• Family Medicine Physician in Oxford, NY
• Providers in Oxford, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2020; 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.