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General NPI Number Information
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NPI Number | 1043605231
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Entity Type | Individual
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Provider Name | JENNY LEE PETRAUSKAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 101 MAIN ST
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City | UNIONVILLE
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State | CT
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Zip | 06085-1131
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Country | US
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Telephone | 860-673-6124
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Fax |
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Provider Business Mailing Address
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Address Line | 67 PUNCH BROOK RD
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City | BURLINGTON
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State | CT
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Zip | 06013-1814
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Country | US
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Telephone | 860-803-2989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 61440
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License Number State | CT
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