Petraco, Douglas Matthew

Petraco, Douglas Matthew is an individual health care provider with primary practice located at 6 Technology Dr Ste 100 , East Setauket NY 11733-4079. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Petraco, Douglas Matthew can be contacted via phone (631) 689-6698.

Contact Information

Primary practice address
6 Technology Dr Ste 100 East Setauket NY 11733-4079
Phone: (631) 689-6698
Fax: (631) 751-5548
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery 207XS0114X 195619 New York
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 195619 New York

Profile Details

NPI number 1922021476
LBN Legal business name Petraco, Douglas Matthew
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 25th, 2006
Last updated Mar 18th, 2019 - about 5 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 1922021476 NPPES
New York MEDICAID 02011645

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