Stephen James Petruccelli, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

X010203 Issued in NY

Practice address

39 Division Street
Sag Harbor, NY 11963

Phone

(631) 725-8209

Fax

(631) 919-1592

NPI assigned

Dec 5, 2006

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

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2001

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• East End Sports Chiropractic, PC

  • Sports Physician Chiropractor
  • Sag Harbor, NY
  • NPI 1215280276
  NPD Authorized official

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300320000000",
    "number": "1710045208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2902",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "119630401",
            "telephone_number": "631-725-8209",
            "fax_number": "631-725-8209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 DIVISION STREET",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "11963",
            "telephone_number": "631-725-8209",
            "fax_number": "631-919-1592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUCCELLI",
        "first_name": "STEPHEN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2011-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NY",
            "license": "X010203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah P Overlock, LAC.
• Susan A Penny, LCSW
• Maria Pentcheva Burns, PSY.D.
• Monica Perrino, DPT
• Cailin McGarry Petersen, OTR/L
• Ilona Katarzyna Polak, M.D.
• Judith Preiato
• Project Solutions, LLC
• Margaret Pulkingham, RN
• Louise Ann Reiner, LPSYA

• Sports Physician Chiropractor in Sag Harbor, NY
• Providers in Sag Harbor, NY by specialty
• Sports Physician Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.