DR. MARY KOSLAP PETRACO NP NPI 1790795896

NPI Information

  • NPI: 1790795896
  • Provider Name: DR. MARY KOSLAP PETRACO, NP
  • Classification: Nurse Practitioner - 363LP0200X
  • Specialization: Pediatrics
  • Entity Type: Individual
  • Address: 1080 SUNRISE HIGHWAY
    MAXINE S POSTAL TRI COMMUNITY HEALTH CENTER
    AMITYVILLE, NY
    ZIP 11701
  • Phone: (631) 854-1000

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NPI Details

DR. Mary Koslap Petraco, NP is a pediatrics nurse practitioner in Amityville, NY. DR. Mary Koslap Petraco, NP NPI is 1790795896. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1080 SUNRISE HIGHWAY
MAXINE S POSTAL TRI COMMUNITY HEALTH CENTER
AMITYVILLE, NY
ZIP 11701
Phone: (631) 854-1000
Fax: (631) 854-1031

The enumeration date for this NPI number is 8/9/2006 and was last updated on 12/9/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0200XNurse PractitionerPediatricsF380420NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100473170MEDICAIDNEW YORK
2W0332100MEDICARE PINNEW YORK
3S84023MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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