Provider Demographics
NPI:1104837293
Name:PETRAS, CHRYSANTHE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRYSANTHE
Middle Name:
Last Name:PETRAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HICKSVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3471
Mailing Address - Country:US
Mailing Address - Phone:516-576-5812
Mailing Address - Fax:516-576-5801
Practice Address - Street 1:175 FULTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3702
Practice Address - Country:US
Practice Address - Phone:516-292-1034
Practice Address - Fax:516-292-0565
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190715-1207PP0204X
NY190715208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY187121Medicaid
NY542701Medicare ID - Type Unspecified
NYG50499Medicare UPIN