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Laura Israelian Petras

Family Medicine

Allopathic & Osteopathic Physicians

632 Broadway Ph, New York, NY 10012-2614

PECOS Enrollment

This provider is enrolled in PECOS as LAURA PETRAS.

Based on the most recent information from CMS, provider Laura Israelian Petras is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1477797967
Provider Type
Individual
Full Name
Petras, Laura Israelian
Title
Dr.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
4/28/2009
Last Updated
1/13/2023

Contact Information

Practice Location

632 Broadway Ph, New York, NY 10012-2614

(347) 294-3414

Unlisted Fax

Mailing Location

64 Bleecker St # 151, New York, NY 10012-2410

(347) 294-3414

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 0101252016 Virginia
Code 207Q00000X	Description Family Medicine Allopathic & Osteopathic Physicians	License 261321 Massachusetts

Laura Israelian Petras

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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Hsiung, Leslie

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