Provider Demographics
NPI:1376610436
Name:PETROV, PETYA (MD)
Entity Type:Individual
Prefix:
First Name:PETYA
Middle Name:
Last Name:PETROV
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 1:39 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6254
Mailing Address - Country:US
Mailing Address - Phone:914-813-2975
Mailing Address - Fax:
Practice Address - Street 1:481 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6324
Practice Address - Country:US
Practice Address - Phone:914-740-4918
Practice Address - Fax:914-740-4917
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219975207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H35660Medicare UPIN