Petros, Jessica Theresa

Petros, Jessica Theresa is an individual health care provider with primary practice located at 3611 21St St , Long Island City NY 11106-4705. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Petros, Jessica Theresa can be contacted via phone (718) 482-7772.

Contact Information

Primary practice address
3611 21St St Long Island City NY 11106-4705
Phone: (718) 482-7772
Fax: (718) 482-9648
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 238271 New York
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 238271 New York

Profile Details

NPI number 1528231016
LBN Legal business name Petros, Jessica Theresa
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 7th, 2008
Last updated Mar 6th, 2014 - about 11 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 1528231016 NPPES
New York MEDICAID 00695941

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