Active NPI
Michael Roman Petronko
- Clinical Psychologist
- Springfield, NJ
National Provider Identifier
1851553028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 950
- Practice address
- 26 Linden Ave
Suite 205-a
Springfield, NJ 07081-1834 - Phone
- (973) 258-1515
- NPI assigned
- Jun 30, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 950 | NJ | Primary |
Addresses
Primary practice location
26 Linden Ave
Suite 205-a
Springfield, NJ 07081-1834
Mailing address
26 Linden Ave
Suite 205-a
Springfield, NJ 07081-1834
Phone (973) 258-1515
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 950 | NJ | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214784000000",
"number": "1851553028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 LINDEN AVE",
"address_2": "SUITE 205-A",
"city": "SPRINGFIELD",
"state": "NJ",
"postal_code": "070811834",
"telephone_number": "973-258-1515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 LINDEN AVE",
"address_2": "SUITE 205-A",
"city": "SPRINGFIELD",
"state": "NJ",
"postal_code": "070811834",
"telephone_number": "973-258-1515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRONKO",
"first_name": "MICHAEL",
"middle_name": "ROMAN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-30",
"last_updated": "2008-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.