Active NPI
Iris M Petrillo, NP
- Family Nurse Practitioner
- Poughkeepsie, NY
National Provider Identifier
1386837524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 335277-1
- Practice address
- 243 North Rd
Suite 304
Poughkeepsie, NY 12601-1172 - Phone
- (845) 471-9410
- Fax
- (845) 471-7943
- NPI assigned
- Aug 21, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 335277-1 | NY | Primary |
Addresses
Primary practice location
243 North Rd
Suite 304
Poughkeepsie, NY 12601-1172
Mailing address
243 North Rd
Suite 304
Poughkeepsie, NY 12601-1172
Phone (845) 471-9410
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 335277-1 | Other | NY | NP LICENSE NUMBER |
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 335277-1 | NY | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187654400000",
"number": "1386837524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "243 NORTH RD",
"address_2": "SUITE 304",
"city": "POUGHKEEPSIE",
"state": "NY",
"postal_code": "126011172",
"telephone_number": "845-471-9410",
"fax_number": "845-471-7943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "243 NORTH RD",
"address_2": "SUITE 304",
"city": "POUGHKEEPSIE",
"state": "NY",
"postal_code": "126011172",
"telephone_number": "845-471-9410",
"fax_number": "845-471-7943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRILLO",
"first_name": "IRIS",
"middle_name": "M",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-21",
"last_updated": "2007-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "335277-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NP LICENSE NUMBER",
"identifier": "335277-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poughkeepsie, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.