Individual
DR. JOHN M PETRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
624 MCCLELLAN STREET, SUITE 101, SCHENECTADY, NY 12304-1020
(518) 382-2260
(518) 347-5007
Mailing address
624 MCCLELLAN STREET, SUITE 101, SCHENECTADY, NY 12304-1020
(518) 382-2260
(518) 347-5007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
239706
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000412108002
BSNENY
NY
05
—
02770294
—
NY
01
—
070216000066
FIDELIS
NY
01
—
111639
GHI HMO
NY
01
—
200391
SENIOR WHOLE HEALTH
NY
01
—
4148P1
EMPIRE BC
NY
01
—
4149233
MVP
NY
01
—
7488829
AETNA
NY
01
—
CDPHP
10112887
NY
Enumeration date
07/12/2006
Last updated
03/26/2009
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