Organization
PETROVANI FAMILY MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PETROVANI MD (OWNER)
(845) 425-4888
Entity
Organization
Contact information
Practice address
10 PARKER PL, FORDS, NJ 08863
(646) 759-5453
(646) 374-4940
Mailing address
10 PARKER PL, FORDS, NJ 08863-2400
(646) 374-4940
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
195910
NY
Other
Enumeration date
12/08/2017
Last updated
11/08/2019
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