Provider Demographics
NPI:1871765131
Name:PETROWSKI, JAMES F (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:PETROWSKI
Suffix:
Gender:M
Credentials:CRNA
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 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0782
Mailing Address - Country:US
Mailing Address - Phone:302-733-0806
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:501 W. FRONT ST
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2101
Practice Address - Country:US
Practice Address - Phone:215-442-5085
Practice Address - Fax:877-329-2370
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00227700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00795719OtherRAILROAD MEDICARE
PARN532786OtherPA LICENSE
079324OtherAANA ID#
NJ26NR12042100OtherRN LICENSE
NJ123133Medicare PIN