Individual
MS. JOHANNA PETRYCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
222 MIDDLE COUNTRY RD, SUITE 228, SMITHTOWN, NY 11787-2871
(631) 265-1351
(631) 265-9363
Mailing address
222 MIDDLE COUNTRY RD, SUITE 228, SMITHTOWN, NY 11787-2871
(631) 265-1351
(631) 265-9363
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012251-1
LICENSE
NY
01
—
1154513117
NPI
NY
Enumeration date
08/14/2007
Last updated
10/10/2008
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