MEDICARE: CHRISTOPHER PAUL PETRELLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	031415-01	NY

General Provider Information

NPI Number	:	1497517783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER PAUL PETRELLA

Provider Business Mailing Address
First Line	:	7202 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1906
Country	:	US
Telephone Number	:	929-491-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	7202 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1906
Country	:	US
Telephone Number	:	929-491-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	01/08/2025

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