MS. JOHANNA PETRYCKI (NPI# 1154513117) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154513117 |
| Entity Type | Individual |
| Full Name | MS. JOHANNA PETRYCKI |
| Credential | P.A. |
| Practice Address |
222 Middle Country Rd Suite 228 Smithtown NY 11787-2871 |
| Practice Telephone | 6312651351 |
| Practice Fax Number | 6312659363 |
| Mailing Telephone | 6312651351 |
| Mailing Fax Number | 6312659363 |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2008-10-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | NPI | 1154513117 | 01 |
| NY | LICENSE | 012251-1 | 01 |
| Street Address |
222 MIDDLE COUNTRY RD SUITE 228 |
| City | SMITHTOWN |
| State | NY |
| Zip Code | 11787-2871 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225021132 | Adi Zion | Physical Therapist | 222 Middle Country Rd, Suite 105, Smithtown, NY 11787-2871 | 2005-08-25 |
| 1134492945 | Michael Domenick Damico | Dentist | 222 Middle Country Rd, Suite 316, Smithtown, NY 11787-2871 | 2012-02-10 |
| 1730408923 | Physicians Private Practice, Pllc | Internal Medicine | 222 Middle Country Rd, Suite 103, Smithtown, NY 11787-2871 | 2010-05-27 |
| 1346484615 | Carol Diane Vogel | Physical Therapist | 222 Middle Country Rd, Suite 105, Smithtown, NY 11787-2871 | 2009-04-29 |
| 1235377276 | Martha Tsarkalis | Family Medicine | 222 Middle Country Rd, Suite 103, Smithtown, NY 11787-2871 | 2009-01-29 |
| 1386828861 | Mark Tan, M.d., P.C. | Specialist | 222 Middle Country Rd, Suite # 312, Smithtown, NY 11787 | 2007-12-20 |
| 1558489864 | North Shore Psychiatric Consultants PC | Psychiatry & Neurology | 222 Middle Country Rd, Suite 210, Smithtown, NY 11787-2814 | 2007-03-26 |
| 1255407987 | Shelley J Epstein | Psychiatry & Neurology | 222 Middle Country Rd, Suite 210, Smithtown, NY 11787-2814 | 2006-11-27 |
| 1407929003 | Robert S Castroll | Psychiatry & Neurology | 222 Middle Country Rd, Suite 210, Smithtown, NY 11787-2814 | 2006-11-15 |
| 1114090719 | Suzanne L Tuzel | Psychiatry & Neurology | 222 Middle Country Rd, Suite 210, Smithtown, NY 11787-2814 | 2006-11-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558962779 | Gwendolyn Burris | Counselor | 20 Gilbert Avenue, Suite 107-a, Smithtown, NY 11787 | 2020-11-04 |
| 1467051193 | Karin M Caro | Adult Companion | 9 Three Pond Road, Smithtown, NY 11787 | 2020-10-23 |
| 1639706641 | Nimit Khara | Student in an Organized Health Care Education/Training Program | 240 Middle Country Rd A, Smithtown, NY 11787 | 2020-03-27 |
| 1003469032 | Maria Teresa Gardella | Nurse Practitioner | St. Catherine of Siena Medical Center, 50 Ny-25a, Smithtown, NY 11787 | 2019-07-18 |
| 1558922070 | Pamella Ann Grillo | Physician Assistant | 373 Ny-111 #5, Smithtown, NY 11787 | 2019-06-25 |
| 1306308127 | Sherry Hansen | Social Worker | 285 Middle Country Rd, Suite Ll5, Smithtown, NY 11787 | 2019-04-01 |
| 1932663747 | Kayla Roundsman | Counselor | 11 Route 11, Smithtown, NY 11787 | 2019-01-25 |
| 1568959856 | Moreen Johnson | Registered Nurse | Christian Nursing Registry, 17 Bank Ave, Smith Town, NY 11787 | 2018-04-23 |
| 1992217871 | Erica Zeller Licensed Clinical Social Work Pllc | Social Worker | 15 Bellemeade Ave Ste 3, Smithtown, NY 11787 | 2017-10-31 |
| 1881117802 | Oisin Vincent Keenan | Case Manager/Care Coordinator | 11 Ny-111, Smithtown, NY 11787 | 2017-07-21 |
| Find all providers in zip 11787 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588228860 | Kyle Godden | Physician Assistant | 257 E Main St Bldg C, Smithtown, NY 11787-2807 | 2019-04-23 |
| 1821406109 | Charles Slowey IIi | Physician Assistant | 9 Ingelore Ct, Smithtown, NY 11787-1705 | 2014-07-30 |
| 1265732374 | Mandy Page | Physician Assistant | 994 Jericho Tpke, Suite 201, Smithtown, NY 11787-3235 | 2010-10-25 |
| 1508035916 | Deborah Leone | Physician Assistant | 29 Ridge Rd, Smithtown, NY 11787-2505 | 2008-02-29 |
| 1265521298 | Susan Conaty | Physician Assistant | 260 Middle Country Road, Suite 208, Smithtown, NY 11787 | 2006-10-11 |
| 1124663505 | Jessica Kristi Angelone | Physician Assistant | 309 E Main St, Smithtown, NY 11787-2844 | 2019-11-09 |
| 1639484207 | Deanna M Krolick | Physician Assistant | 48 Route 25a Ste 301, Smithtown, NY 11787-1454 | 2010-08-08 |
| 1710151949 | Kimberly Grace Schmidt | Physician Assistant | 496 Smithtown Byp Ste 200, Smithtown, NY 11787 | 2008-04-18 |
| 1902930738 | Esther K. Kopiec-levine | Physician Assistant | 327 E Main St, Smithtown, NY 11787-2905 | 2007-03-15 |
| 1952408395 | Gerard Anthony Squittiere | Physician Assistant | 50 Route 25a, Smithtown, NY 11787-1348 | 2006-09-20 |
| Find all providers in SMITHTOWN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.