Provider Demographics
NPI:1881767127
Name:PETRANKER, STEPHAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:PETRANKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY
Mailing Address - Street 2:3A - 30
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:845-369-7118
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:3A - 30
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8496
Practice Address - Fax:718-963-8501
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170664-2207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY170664-2OtherNYS LICENSE