Provider Demographics
NPI:1992984223
Name:PETRAS, CHRISTINE MARIE (PA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:PETRAS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2805 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7647
Mailing Address - Country:US
Mailing Address - Phone:631-638-8300
Mailing Address - Fax:631-738-8500
Practice Address - Street 1:2805 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 8
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7647
Practice Address - Country:US
Practice Address - Phone:631-638-8300
Practice Address - Fax:631-738-8500
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2011-05-06
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Provider Licenses
StateLicense IDTaxonomies
NYP61711363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant