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General NPI Number Information
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NPI Number | 1821093444
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Entity Type | Individual
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Provider Name | GEORGE A. PETROSSIAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 1405 OLD NORTHERN BLVD
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City | ROSLYN
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State | NY
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Zip | 11576-2252
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Country | US
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Telephone | 516-484-6777
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Fax | 516-484-0037
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Provider Business Mailing Address
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Address Line | PO BOX 95000-6600
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City | PHILADELPHIA
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State | PA
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Zip | 19195-6600
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Country | US
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Telephone | 631-465-6297
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Fax | 631-465-6524
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 159502-1
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License Number State | NY
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