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Michael James Petersen, MD
Vascular Surgery Physician in East Setauket, New York
NPI 1902899057

Michael James Petersen is a Vascular Surgery Physician based in East Setauket, NY and is specialized in Vascular Surgery. Michael James Petersen practices in East Setauket, NY and has the professional credentials of MD. The NPI Number for Michael James Petersen is 1902899057 and holds a License No. 175936 (New York).

The current practice location address for Michael James Petersen is 4 Technology Dr, East Setauket, NY and can be reached out via phone at 631-246-8289 and via fax at 631-246-8294.

Location: 4 Technology Dr, East Setauket, NY, 11733-4068
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1902899057
Provider Name
Michael James Petersen
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
4 Technology Dr, East Setauket, NY, 11733-4068
Phone Number
631-246-8289
Fax Number
631-246-8294
Provider Enumeration Date
08/24/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2C4298 01 NY HEALTHNET
0714028004 01 NY CIGNA HEALTHCARE
990015026 01 NY RR MEDICARE
S500051 01 NY SUFFOLK HEALTH PLANS
11347567803 01 NY 1199 BENEFIT FUND
2110430 01 NM AETNA HEALTH PLANS
CS1072 01 NY OXFORD HEALTH PLANS
1261940 01 NY UNITED HEALTHCARE
GHI PPO CBP 01 NM 0103702
institution
Provider Business Practice Location Address Details
Address
4 Technology Dr
City
East Setauket
State
New York
Zip
11733-4068
Phone Number
631-246-8289
Fax Number
631-246-8294
person
Provider Business Mailing Address Details
Address
4 Technology Dr
City
East Setauket
State
New York
Zip
11733-4068
Phone Number
631-246-8289
Fax Number
631-246-8294
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
175936 (New York)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Surgery
Speciality
Vascular Surgery
Taxonomy
2086S0129X
License No.
175936 (New York)
Definition
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
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