Active NPI
Joseph A Petrosino, P.A.
- Physician Assistant
- Schenectady, NY
National Provider Identifier
1124022611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 004476-1
- Practice address
- 2125 River Rd Ste 303
Schenectady, NY 12309-1135 - Phone
- (518) 831-2500
- Fax
- (518) 831-2510
- NPI assigned
- Jun 13, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004476-1 | NY | Primary |
Addresses
Primary practice location
2125 River Rd Ste 303
Schenectady, NY 12309-1135
Mailing address
711 Troy Schenectady Rd Ste 201
Latham, NY 12110-2482
Phone (518) 782-3700
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004476 | NY | MD | Acupuncturist |
| 004476-1 | NY | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565049600000",
"number": "1124022611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 TROY SCHENECTADY RD STE 201",
"city": "LATHAM",
"state": "NY",
"postal_code": "121102482",
"telephone_number": "518-782-3700",
"fax_number": "518-782-3799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2125 RIVER RD STE 303",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123091135",
"telephone_number": "518-831-2500",
"fax_number": "518-831-2510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROSINO",
"first_name": "JOSEPH",
"middle_name": "A",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-13",
"last_updated": "2019-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "004476-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Schenectady, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.