Provider Demographics
NPI:1457525768
Name:PETITO, ANNA
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:
Last Name:PETITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 PARK AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0323
Mailing Address - Country:US
Mailing Address - Phone:212-249-8700
Mailing Address - Fax:212-327-4405
Practice Address - Street 1:975 PARK AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0323
Practice Address - Country:US
Practice Address - Phone:212-249-8700
Practice Address - Fax:212-327-4405
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009911363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant