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:
Health care specialties
| Specialty | Code | License # | 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 12 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528231016 | NPPES |
| New York | MEDICAID | 00695941 |
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