1154546000 NPI number — MRS. AMY R PETRIE M.D.

Table of content: MRS. AMY R PETRIE M.D. (NPI 1154546000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154546000 NPI number — MRS. AMY R PETRIE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETRIE
Provider First Name:
AMY
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SADOWITZ
Provider Other First Name:
AMY
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154546000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5800 HERITAGE LANDING DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
EAST SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13057-9378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-445-2701
Provider Business Mailing Address Fax Number:
315-445-2847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5800 HERITAGE LANDING DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
EAST SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13057-9378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-445-2701
Provider Business Practice Location Address Fax Number:
315-445-2847
Provider Enumeration Date:
04/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  243100 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)