Petersen, Michael James

Petersen, Michael James is an sole proprietor health care provider with primary practice located at 4 Technology Dr Suite 120, East Setauket NY 11733-4068. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is his primary health care specialty. Petersen, Michael James can be contacted via phone (631) 246-8289.

Contact Information

Primary practice address
4 Technology Dr Suite 120 East Setauket NY 11733-4068
Phone: (631) 246-8289
Fax: (631) 246-8294
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 175936 New York
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 175936 New York

Profile Details

NPI number 1902899057
LBN Legal business name Petersen, Michael James
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 24th, 2005
Last updated Jun 6th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902899057 NPPES
New York Other 2C4298 HEALTHNET
New York Other 0714028004 HEALTHNET
New York Other 990015026 HEALTHNET
New York Other S500051 HEALTHNET
New York Other 11347567803 HEALTHNET
New York Other 2110430 HEALTHNET
New York Other CS1072 HEALTHNET
New York Other 1261940 HEALTHNET
New York Other GHI PPO CBP HEALTHNET

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