Provider Demographics
NPI:1962249904
Name:PETROWSKY, KRISTY LYNN
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:PETROWSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 923
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-0923
Mailing Address - Country:US
Mailing Address - Phone:845-747-2580
Mailing Address - Fax:845-292-0121
Practice Address - Street 1:5 TRIANGLE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-3368
Practice Address - Country:US
Practice Address - Phone:845-747-2580
Practice Address - Fax:845-292-0121
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator