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NPI Code Detail

MEDICARE: ELIZABETH RUTH PETRAKAKOS RN

MEDICARE: ELIZABETH RUTH PETRAKAKOS RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1942163498
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH RUTH PETRAKAKOS RN
Provider Business Mailing Address
First Line : 200 PORTLAND RD APT D-3
Second Line :
City : HIGHLANDS
State : NJ
Zip : 07732-1933
Country : US
Telephone Number : 540-322-6533
Fax Number :
Provider Business Practice Location Address
First Line : 201 LYONS AVE
Second Line :
City : NEWARK
State : NJ
Zip : 07112-2027
Country : US
Telephone Number : 540-322-6533
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2025
Last Update Date : 12/03/2025

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