Staten Island Nephrology PC
Internal Medicine, Nephrology in Staten Island, NY. Organization (NPI-2).
Details
- NPI
- 1982682001
- Entity type
- Organization (NPI-2)
- Legal business name
- Staten Island Nephrology PC
- Organization subpart
- No
- Enumeration date
- Jan 9, 2006
- Last updated
- Feb 8, 2008
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RN0300X | Internal Medicine, Nephrology | – | – | Yes |
Practice location
1366 Victory BlvdStaten Island, NY 10301-3907
Phone 718-727-3402 · Fax 718-727-3402
Mailing address
1366 Victory BlvdStaten Island, NY 10301-3907
Phone 718-727-3402 · Fax 718-727-3402
Authorized official
Eugene Petra
Owner
7182733400
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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