Active NPI
Dale A Petroff, PA
- Medical Physician Assistant
- Syracuse, NY
National Provider Identifier
1952395188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 003830
- Practice address
- 750 E Adams St
Syracuse, NY 13210-2306 - Phone
- (315) 464-5612
- Fax
- (315) 464-6520
- NPI assigned
- Sep 2, 2005
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 003830 | NY | Primary |
Addresses
Primary practice location
750 E Adams St
Syracuse, NY 13210-2306
Mailing address
4549 Summerfield Dr
Cazenovia, NY 13035-9766
Phone (315) 655-9089
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0038301 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suny Health Science Center at Syracuse | Current | Accepting new patients |
Locations
750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363
Organizations & group practices 5
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.
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- NPI 1003075029
-
- Hospitalist Physician
- Rochester, NY
- NPI 1922270420
-
- Critical Access Hospital
- Alexandria Bay, NY
- NPI 1003814641
-
dba Upstate University Hospital
- General Acute Care Hospital
- Syracuse, NY
- NPI 1184974529
-
dba Upstate Outpatient Pharmacy at Nappi
- Pharmacy
- Syracuse, NY
- NPI 1306567474
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1952395188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4549 SUMMERFIELD DR",
"city": "CAZENOVIA",
"state": "NY",
"postal_code": "130359766",
"telephone_number": "315-655-9089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 E ADAMS ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132102306",
"telephone_number": "315-464-5612",
"fax_number": "315-464-6520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROFF",
"first_name": "DALE",
"middle_name": "A",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NY",
"license": "003830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.