1750647210 NPI number — NYC DOE OFFICE OF SCHOOL HEALTH

Table of content: MARY JO PETRAS MA CCCA FAAA (NPI 1093807281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750647210 NPI number — NYC DOE OFFICE OF SCHOOL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYC DOE OFFICE OF SCHOOL HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750647210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
413 EAST 120TH STREET 2ND FLOOR
Provider Second Line Business Mailing Address:
HARLEM MULTI SERVICE CENTER - DOHMH
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10463-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-807-2359
Provider Business Mailing Address Fax Number:
917-492-6977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
413 EAST 120TH STREET 2ND FLOOR
Provider Second Line Business Practice Location Address:
HARLEM MULTI SERVICE CENTER - DOHMH
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10463-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-807-2359
Provider Business Practice Location Address Fax Number:
917-492-6977
Provider Enumeration Date:
04/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TRAVERS
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF NURSING
Authorized Official Telephone Number:
347-396-4717

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  351264 , 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)





Copyright © 2007-2025 www.npivalidator.com