Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 190715-1 | NY |
Y | 208000000X | Pediatrician | 190715 | NY |
NPI | 1104837293 |
---|---|
Provider Name | Dr. Chrysanthe Petras |
First Address | Bethpage, NY 11714-3471 |
Second Address | Hempstead, NY 11550-3702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 13/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
187121 | (05) | NY |
G50499 | (02) | NY |