Provider Demographics
NPI:1508361213
Name:PETTET, DONALD WILLIAM III (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WILLIAM
Last Name:PETTET
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COMMUNITY DRIVE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:718-415-5631
Mailing Address - Fax:
Practice Address - Street 1:300 COMMUNITY DRIVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:718-415-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302438-01207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine