Provider Demographics
NPI:1265536866
Name:PETRO, JANE A (MD, FACS)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:A
Last Name:PETRO
Suffix:
Gender:F
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E MAIN ST
Mailing Address - Street 2:NORTH BUILDING
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3417
Mailing Address - Country:US
Mailing Address - Phone:914-242-7610
Mailing Address - Fax:914-241-3239
Practice Address - Street 1:400 E MAIN ST
Practice Address - Street 2:NORTH BUILDING
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3417
Practice Address - Country:US
Practice Address - Phone:914-242-7610
Practice Address - Fax:914-241-3239
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1404141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21A401Medicare ID - Type UnspecifiedMEDICARE # - MT. KISCO
NYD46878Medicare UPIN