Individual
DR. PETR ITZHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6805 MYRTLE AVE, GLENDALE, NY 11385-7267
(718) 366-2242
Mailing address
6805 MYRTLE AVE, GLENDALE, NY 11385-7267
(718) 366-2242
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
234430
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02669836
—
NY
Enumeration date
05/28/2006
Last updated
08/07/2007
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