Provider Demographics
NPI:1285300954
Name:PETRERA, MASSIMO ORONZO (MD, FRCSC)
Entity type:Individual
Prefix:
First Name:MASSIMO
Middle Name:ORONZO
Last Name:PETRERA
Suffix:
Gender:M
Credentials:MD, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MADISON AVE APT 11J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5483
Mailing Address - Country:US
Mailing Address - Phone:332-209-8113
Mailing Address - Fax:
Practice Address - Street 1:301 E 17TH ST RM 1402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:332-209-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312354207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine