Basic Information
| Provider Information | |||||||||
| NPI: | 1326487075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETITME | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | EDITH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 506 LENOX AVE | ||||||||
| Address2: | MLK 6227 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129391277 | ||||||||
| FaxNumber: | 2129392195 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 BROAD ST RM 815 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100043233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183910611 | ||||||||
| FaxNumber: | 7187322638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2013 | ||||||||
| LastUpdateDate: | 05/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F337573 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | F337573-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.