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Organization
LAURIS J. PETERSEN MD PC
Active
Organization
LAURIS J. PETERSEN MD PC
Active
Other names
GLENRIDGE FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURIS JON PETERSEN MD (CEO/PRESIDENT)
(518) 399-0909
Entity
Organization
Contact information
Practice address
15 GLENRIDGE RD, GLENVILLE, NY 12302-4520
(518) 399-0909
(518) 399-2640
Mailing address
15 GLENRIDGE RD, GLENVILLE, NY 12302-4520
(518) 399-0909
(518) 399-2640
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
213320
NY
Other
Enumeration date
08/10/2007
Last updated
08/10/2007
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