Provider Demographics
NPI:1174028799
Name:PETRUCCELLI, FILIPPA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:FILIPPA
Middle Name:
Last Name:PETRUCCELLI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CENTRAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2030
Mailing Address - Country:US
Mailing Address - Phone:857-205-9747
Mailing Address - Fax:
Practice Address - Street 1:2200 NORTHERN BLVD STE 133
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1226
Practice Address - Country:US
Practice Address - Phone:516-352-8100
Practice Address - Fax:516-352-7348
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3080661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine