Provider Demographics
NPI:1508409038
Name:THREE GENERATIONS MEDICAL PC
Entity type:Organization
Organization Name:THREE GENERATIONS MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PETYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-813-2975
Mailing Address - Street 1:39 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8027 135TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1029
Practice Address - Country:US
Practice Address - Phone:718-544-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty