Mary Koslap Petraco, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

F380420 Issued in NY

Practice address

1080 Sunrise Highway
Maxine S Postal Tri Community Health Center
Amityville, NY 11701

Phone

(631) 854-1000

Fax

(631) 854-1031

NPI assigned

Aug 9, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323388800000",
    "number": "1790795896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 SUNRISE HIGHWAY",
            "address_2": "MAXINE S POSTAL TRI COMMUNITY HEALTH CENTER",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "11701",
            "telephone_number": "631-854-1000",
            "fax_number": "631-854-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 SUNRISE HIGHWAY",
            "address_2": "MAXINE S POSTAL TRI COMMUNITY HEALTH CENTER",
            "city": "AMITYVILLE",
            "state": "NY",
            "postal_code": "11701",
            "telephone_number": "631-854-1000",
            "fax_number": "631-854-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSLAP PETRACO",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2011-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F380420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473170",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald F Klinger, M.D.
• Dawn Melinda Knapper, L.C.SW
• Knickerbocker Dialysis Inc
• Tia L Knight-Forbes, FNP-BC
• Lauren Kolonoskie
• Colleen Kretz
• Kerry Ann Krohn, M.S
• Sara Gabrielle Kucker
• Karan Kumar, MD
• Raman Kumar, MD

• Pediatric Nurse Practitioner in Amityville, NY
• Providers in Amityville, NY by specialty
• Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; 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.