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General NPI Number Information
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NPI Number | 1821902792
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY PETROCCI
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Gender | Male
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 159 WOLF RD STE 105
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City | ALBANY
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State | NY
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Zip | 12205-6008
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Country | US
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Telephone | 518-437-0152
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Fax |
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Provider Business Mailing Address
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Address Line | 219 DEER RUN DR APT C
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City | HUDSON FALLS
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State | NY
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Zip | 12839-2757
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Country | US
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Telephone | 518-479-7862
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 342928
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License Number State | NY
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