Healthcare Provider Details

I. General information

NPI: 1427088376
Provider Name (Legal Business Name): LOUIS GEORGE PETCU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CRYSTAL RUN RD STE 220
MIDDLETOWN NY
10941
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 845-467-6998
  • Fax: 845-692-0675
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number041922
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number75221
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number75221
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number041922
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number297344
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: