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General NPI Number Information
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NPI Number | 1336206952
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Entity Type | Individual
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Provider Name | ERCOLE JOHN PETRUNGARO PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 333 1ST ST STE A
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City | SAN FRANCISCO
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State | CA
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Zip | 94105-2661
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Country | US
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Telephone | 888-803-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 10 LAFAYETTE ST
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City | STATEN ISLAND
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State | NY
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Zip | 10307-1225
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Country | US
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Telephone | 917-921-7226
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00256900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 010815
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010815
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License Number State | NY
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