Provider Demographics
NPI:1952345761
Name:PETRUCCI, DEBRA A (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:PETRUCCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAFAYETTE CT
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3036
Mailing Address - Country:US
Mailing Address - Phone:845-896-9200
Mailing Address - Fax:203-622-1240
Practice Address - Street 1:4 LAFAYETTE CT
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-896-9200
Practice Address - Fax:203-622-1240
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 190465207T00000X
NY190465207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY190465OtherNY STATE LICENSE
NY10L091Medicare ID - Type Unspecified