MEDICARE: PAULA D PETROSINO DPM

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	213E00000X	Podiatrist	MD01407	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811045164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA D PETROSINO DPM

Provider Business Mailing Address
First Line	:	GULFVIEW CLUB 2204
Second Line	:	58 N COLLIER BLVD
City	:	MARCO ISLAND
State	:	FL
Zip	:	34145-3711
Country	:	US
Telephone Number	:	201-314-2415
Fax Number	:	239-394-5033

Provider Business Practice Location Address
First Line	:	129 CENTRAL AVE
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1306
Country	:	US
Telephone Number	:	201-314-2415
Fax Number	:	239-394-5033

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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Directions to “ PAULA D PETROSINO DPM” Practice Location

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