Active NPI
Christine Marie Petras, PA
- Physician Assistant
- Ronkonkoma, NY
National Provider Identifier
1992984223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- P61711
- Practice address
- 2805 Veterans Memorial Hwy
Suite 8
Ronkonkoma, NY 11779-7647 - Phone
- (631) 638-8300
- Fax
- (631) 738-8500
- NPI assigned
- Nov 2, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | P61711 | NY | Primary |
Addresses
Primary practice location
2805 Veterans Memorial Hwy
Suite 8
Ronkonkoma, NY 11779-7647
Mailing address
2805 Veterans Memorial Hwy
Suite 8
Ronkonkoma, NY 11779-7647
Phone (631) 638-8300
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P61711 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304640000000",
"number": "1992984223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2805 VETERANS MEMORIAL HWY",
"address_2": "SUITE 8",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117797647",
"telephone_number": "631-638-8300",
"fax_number": "631-738-8500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 VETERANS MEMORIAL HWY",
"address_2": "SUITE 8",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117797647",
"telephone_number": "631-638-8300",
"fax_number": "631-738-8500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRAS",
"first_name": "CHRISTINE",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-02",
"last_updated": "2011-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "P61711",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ronkonkoma, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.