Provider Demographics
NPI:1861714800
Name:DEBRA A. PETRUCCI, M.D., P.C.
Entity type:Organization
Organization Name:DEBRA A. PETRUCCI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETRUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-949-9449
Mailing Address - Street 1:P.O. BOX 848518
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8518
Mailing Address - Country:US
Mailing Address - Phone:914-949-9449
Mailing Address - Fax:914-949-9445
Practice Address - Street 1:222 WESTCHESTER AVENUE
Practice Address - Street 2:SUITE 403
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2906
Practice Address - Country:US
Practice Address - Phone:914-949-9449
Practice Address - Fax:914-949-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60190465207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty