Provider Demographics
NPI:1548420508
Name:PETRUCELLI, ROBERT P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
Last Name:PETRUCELLI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:462 1ST AVE
Mailing Address - Street 2:DEPT. OF REHABILITATION MEDICINE, NEW BELLEVUE 6, 6S3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9196
Mailing Address - Country:US
Mailing Address - Phone:212-562-3603
Mailing Address - Fax:212-562-3606
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:DEPT. OF REHABILITATION MEDICINE, NEW BELLEVUE 6, 6S3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-3603
Practice Address - Fax:212-562-3606
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2010-09-16
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Provider Licenses
StateLicense IDTaxonomies
NY247322208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation