Organization
LAURIS J. PETERSEN MD PC
Active
Other names
GLENRIDGE FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURIS JON PETERSEN MD (CEO/PRESIDENT)
(518) 399-0909
Entity
Organization
Contact information
Practice address
15 GLENRIDGE RD, GLENVILLE, NY 12302-4520
(518) 399-0909
(518) 399-2640
Mailing address
15 GLENRIDGE RD, GLENVILLE, NY 12302-4520
(518) 399-0909
(518) 399-2640
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
213320
NY
Other
Enumeration date
08/10/2007
Last updated
08/10/2007
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