Individual
OWEN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
121 EVERETT RD, ALBANY, NY 12205-1474
(518) 489-2663
(518) 689-3881
Mailing address
121 EVERETT RD, ALBANY, NY 12205-1474
(518) 489-2663
(518) 689-3881
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
027272
NY
363AS0400X
Surgical Physician Assistant
Primary
027272
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06817683
—
NY
Enumeration date
01/02/2017
Last updated
07/16/2025
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