Individual
DR. MARY KOSLAP PETRACO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1080 SUNRISE HIGHWAY, MAXINE S POSTAL TRI COMMUNITY HEALTH CENTER, AMITYVILLE, NY 11701
(631) 854-1000
(631) 854-1031
Mailing address
1080 SUNRISE HIGHWAY, MAXINE S POSTAL TRI COMMUNITY HEALTH CENTER, AMITYVILLE, NY 11701
(631) 854-1000
(631) 854-1031
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F380420
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00473170
—
NY
Enumeration date
08/09/2006
Last updated
12/09/2011
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