Marcia Petitt

NPI #1063777233 in Woodside, New York

Provider Information

NPI Number: 1063777233
Entity Type: Individual
Name: Marcia Petitt
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Enumeration Date: Jul 12, 2012
Last Updated: Dec 13, 2012

Practice Location

Address: 6311 QUEENS BLVD
Address 2: APT B-16
City: Woodside
State: New York
ZIP Code: 11377-5764
Phone: (718) 457-2180

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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