Organization
STATEN ISLAND NEPHROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EUGENE PETRA MD (OWNER)
(718) 273-3400
Entity
Organization
Contact information
Practice address
1366 VICTORY BLVD, STATEN ISLAND, NY 10301-3907
(718) 727-3402
(718) 727-3402
Mailing address
1366 VICTORY BLVD, STATEN ISLAND, NY 10301-3907
(718) 727-3402
(718) 727-3402
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02544181
—
NY
Enumeration date
01/09/2006
Last updated
02/08/2008
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