Robert K. Petrelli, OD

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

NJ3013 Issued in NJ

Legal business name

ROBERT K. PETRELLI, OD

Practice address

1400 New Jersey Ave
North Wildwood, NJ 08260-2738

Phone

(609) 522-4199

Fax

(609) 522-3692

NPI assigned

Nov 30, 2007

Last updated

Dec 4, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert K Petrelli Sr., D.O.NPI 1699772988

Title

Owner

Phone

(609) 522-4199

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert K Petrelli, O.D.

  • Optometrist
  • North Wildwood, NJ
  • NPI 1699772988
  NPD (past) Authorized official
• Mark W Petrelli, O.D.

  • Corneal and Contact Management Optometrist
  • Wildwood, NJ
  • NPI 1427010271
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1083896153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 NEW JERSEY AVE",
            "city": "NORTH WILDWOOD",
            "state": "NJ",
            "postal_code": "082602738",
            "telephone_number": "609-522-4199",
            "fax_number": "609-522-3692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 NEW JERSEY AVE",
            "city": "NORTH WILDWOOD",
            "state": "NJ",
            "postal_code": "082602738",
            "telephone_number": "609-522-4199",
            "fax_number": "609-522-3692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT K. PETRELLI, OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "PETRELLI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-522-4199",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "PA",
            "license": "PA-OE004707L",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NJ",
            "license": "NJ3013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2400901",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "455040",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0097739000",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• North Wildwood Medical Associates, PA
• Christina Rose O'Halloran, PT, DPT
• Timothy Michael Palombo, RPH
• Sean Persaud
• Robert K Petrelli, O.D.
• Vickie L Smith, MFT, LPC
• Warrior Cognitive and Psychological Services
• Victoria Wells-Manlandro, M.S.W.

• Customized Equipment (DME) in North Wildwood, NJ
• Providers in North Wildwood, NJ by specialty
• Customized Equipment (DME) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.