Provider Demographics
NPI:1033465174
Name:PETRONELLA, PATRICIA A (MS SPEC ED)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:PETRONELLA
Suffix:
Gender:F
Credentials:MS SPEC ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAVID LANE
Mailing Address - Street 2:#6M
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:914-966-0610
Mailing Address - Fax:
Practice Address - Street 1:1053 SAWMILL RIVER RD.
Practice Address - Street 2:HTA OF NEW YORK
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502
Practice Address - Country:US
Practice Address - Phone:914-674-0733
Practice Address - Fax:914-674-0285
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist