Peter James Petrulis, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

160527 Issued in NY

Practice address

10 Gagnon Dr
Stone Ridge, NY 12484-5120

Phone

(845) 687-9933

NPI assigned

Aug 16, 2005

Last updated

Feb 11, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rondout Valley Family Med PC

  • Family Medicine Physician
  • Stone Ridge, NY
  • NPI 1679514004
  Authorized official Same address or phone

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202688000000",
    "number": "1669464624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "city": "STONE RIDGE",
            "state": "NY",
            "postal_code": "124840547",
            "telephone_number": "845-687-9933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 GAGNON DR",
            "city": "STONE RIDGE",
            "state": "NY",
            "postal_code": "124845120",
            "telephone_number": "845-687-9933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRULIS",
        "first_name": "PETER",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2008-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "160527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "087250",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00950523",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Murphy, M.S., CCC-SLP
• Helena Nikolajevic, LAC
• Kelly Oconnell
• Deepak Parikh, MD
• Phillip Parker, DDS
• Phillip E. Parker, D.D.S., PC
• Kevin Paul Placentino, RPH
• Priscilla Alden Reynolds, R.N., F.N.P.
• Tiffany Robinson
• Rondout Valley Family Dentistry

• Family Medicine Physician in Stone Ridge, NY
• Providers in Stone Ridge, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; 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.