MEDICARE: PETIA TRIFONOVA PAPAZOGLOU NURSE PRACTITIONAL

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	401650	NY

General Provider Information

NPI Number	:	1558798850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETIA TRIFONOVA PAPAZOGLOU NURSE PRACTITIONAL

Provider Business Mailing Address
First Line	:	7620 BAY PKWY
Second Line	:	SUITE 1B
City	:	BROOKLYN
State	:	NY
Zip	:	11214
Country	:	US
Telephone Number	:	516-361-4120
Fax Number	:

Provider Business Practice Location Address
First Line	:	7620 BAY PKWY
Second Line	:	SUITE 1B
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1532
Country	:	US
Telephone Number	:	718-232-1492
Fax Number	:

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

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	10/01/2013

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