Active NPI
Marcia Petitt
- Specialist
- Woodside, NY
National Provider Identifier
1063777233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 638064041
- Practice address
- 6311 Queens Blvd
Apt B-16
Woodside, NY 11377-5764 - Phone
- (718) 457-2180
- NPI assigned
- Jul 12, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 638064041 | NY | Primary |
Addresses
Primary practice location
6311 Queens Blvd
Apt B-16
Woodside, NY 11377-5764
Mailing address
6311 Queens Blvd
Apt B-16
Woodside, NY 11377-5764
Phone (718) 457-2180
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 638064041 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355356800000",
"number": "1063777233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6311 QUEENS BLVD",
"address_2": "APT B-16",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "113775764",
"telephone_number": "718-457-2180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6311 QUEENS BLVD",
"address_2": "APT B-16",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "113775764",
"telephone_number": "718-457-2180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETITT",
"first_name": "MARCIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-07-12",
"last_updated": "2012-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "638064041",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodside, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.