Individual
LEAH PETRUCELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13303 JAMAICA AVE, JAMAICA, NY 11418-2618
(718) 657-7093
Mailing address
13303 JAMAICA AVE, JAMAICA, NY 11418-2618
(718) 739-5712
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
331373
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/02/2019
Last updated
10/31/2024
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