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General NPI Number Information
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NPI Number | 1356585673
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Entity Type | Individual
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Provider Name | THEODORA NIKI PETRATOS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/30/2009
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | ONE GUSTAVE L LEVY PLACE MOUNT SINAI MEDICAL CENTER/OPHTHALMOLOGY, ONE GUSTAVE L
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City | NEW YORK
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State | NY
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Zip | 10029
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Country | US
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Telephone | 212-241-6752
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Fax | 212-241-5764
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Provider Business Mailing Address
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Address Line | ONE GUSTAVE L LEVY PLACE P. O. BOX 1183 MOUNT SINAI MEDICAL CENTER/OPHTHALMOLOGY, ONE GUSTAVE L
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City | NEW YORK
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State | NY
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Zip | 10029
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Country | US
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Telephone | 212-241-6752
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Fax | 212-241-5764
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 252692
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License Number State | NY
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