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1710927710
RUSSELL PETRIE
UTICA, NY
NPI
1710927710
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NY 004697)
Enumeration Date
2006-06-07
Last Update Date
2007-07-16
Business Address
-- RUSSELL PETRIE PA-C
2209 GENESEE ST
UTICA, NY 13501-5930
Phone number: 315-798-8111
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Mailing Address
-- RUSSELL PETRIE PA-C
307 S EVERGREEN AVE
WOODBURY, NJ 08096-2739
Phone number: 856-686-4300
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