MICHAEL JAMES PETERSEN (NPI# 1902899057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902899057 |
| Entity Type | Individual |
| Full Name | MICHAEL JAMES PETERSEN |
| Credential | M.D. |
| Practice Address |
4 Technology Dr Suite 120 East Setauket NY 11733-4068 |
| Practice Telephone | 6312468289 |
| Practice Fax Number | 6312468294 |
| Mailing Telephone | 6312468289 |
| Mailing Fax Number | 6312468294 |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2016-06-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 175936 | NY | Other Service Providers |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
175936 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | UNITED HEALTHCARE | 1261940 | 01 |
| NY | OXFORD HEALTH PLANS | CS1072 | 01 |
| NM | 0103702 | GHI PPO CBP | 01 |
| NY | SUFFOLK HEALTH PLANS | S500051 | 01 |
| NY | CIGNA HEALTHCARE | 0714028004 | 01 |
| NY | 1199 BENEFIT FUND | 11347567803 | 01 |
| NY | RR MEDICARE | 990015026 | 01 |
| NM | AETNA HEALTH PLANS | 2110430 | 01 |
| NY | HEALTHNET | 2C4298 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740602960 | Michael Petersen | Veterinarian | 5754 Nicollet Ave, Minneapolis, MN 55419-2415 | 2014-01-07 |
| 1407902307 | Michael James Petersen | Dentist | 3101 Old Highway 8, Suite #303, Roseville, MN 55113-1072 | 2007-01-25 |
| 1881798379 | Michael Charles Petersen | Pediatrics | 12356 Riata Trace Pkwy # 6006-b, Austin, TX 78727-6417 | 2006-09-12 |
| 1629005160 | Michael R Petersen | Ophthalmology | 2000 N Huron River Dr Ste 100, Ypsilanti, MI 48197 | 2006-06-28 |
| 1467428656 | Michael S Petersen | Orthopaedic Surgery | 2020 Sutter Pl, Suite 104, Davis, CA 95616-6213 | 2006-02-27 |
| 1609849736 | Michael T Petersen | Anesthesiology | 25 Main Pl, Suite 425, Council Bluffs, IA 51503-0792 | 2006-02-09 |
| 1639785579 | Michael Lee Petersen | Pharmacist | 900 W Clairemont Ave, Eau Claire, WI 54701-6122 | 2020-09-16 |
| 1780248146 | Michael Jake Petersen | Student in an Organized Health Care Education/Training Program | 600 S Paulina St Ste 403, Chicago, IL 60612-3806 | 2019-04-30 |
| 1093182552 | Michael Petersen | Counselor | 1067 E Tabernacle St, Suite 7, Saint George, UT 84770-3163 | 2015-08-31 |
| 1972746931 | Michael G Petersen | Physician Assistant | 7201 Manchaca Rd, Ste B, Austin, TX 78745-5283 | 2009-04-07 |
| Street Address |
4 TECHNOLOGY DR SUITE 120 |
| City | EAST SETAUKET |
| State | NY |
| Zip Code | 11733-4068 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114921558 | Jack Oats | Ophthalmology | 4 Technology Dr, Suite 150, East Setauket, NY 11733-4080 | 2005-06-13 |
| 1346774122 | Setauket Medical, PC | Internal Medicine | 4 Technology Dr, Suite 220, East Setauket, NY 11733-4080 | 2017-04-18 |
| 1104287432 | Setauket Surgery, PC | Surgery | 4 Technology Dr, Suite 220, East Setauket, NY 11733-4080 | 2016-03-15 |
| 1902279029 | Lisa Ambrose | Nurse Practitioner | 4 Technology Dr, Suite 120, East Setauket, NY 11733-4080 | 2015-11-11 |
| 1376940742 | Blue Harbor Medical PC | Surgery | 4 Technology Dr, Suite 240, East Setauket, NY 11733-4080 | 2014-12-01 |
| 1437565520 | Jaclyn N Mascia | Dietitian, Registered | 4 Technology Dr, Suite 250, East Setauket, NY 11733-4080 | 2014-07-09 |
| 1184030918 | Karim A Paracha Physician PC | Surgery | 4 Technology Dr, Suite 240, East Setauket, NY 11733-4080 | 2014-07-01 |
| 1255741153 | Harbor View Medical Services, P.C. | Surgery | 4 Technology Dr, Suite 120, East Setauket, NY 11733-4080 | 2014-04-30 |
| 1437582103 | Shelly Beth Waldman | Pediatrics | 4 Technology Dr, East Setauket, NY 11733-4080 | 2013-08-16 |
| 1598101180 | Vicki Kumari Masson | Pediatrics | 4 Technology Dr, East Setauket, NY 11733-4080 | 2013-05-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063033991 | Olivia Carlino | Registered Nurse | 28 Buckingham Meadow Road, Setauket, NY 11733 | 2020-05-01 |
| 1295392553 | Johnny Slade | Emergency Medicine | 11 Bridge Rd, East Setauket, NY 11733 | 2019-05-22 |
| 1275060345 | Donna M Sweeney | Specialist | 14 Research Way East, East Setauket, NY 11733 | 2017-05-18 |
| 1659806388 | Erin Kunz | Podiatrist | Stony Brook Surgical Associates, 37 Research Way, Setauket- East Setauket, NY 11733 | 2017-05-01 |
| 1285180521 | Allison M Pinard | Specialist/Technologist | 149 Old Field Road, Setauket, NY 11733 | 2016-08-28 |
| 1578915096 | Kristyn Matovich | Behavioral Analyst | 5 Kenwood Street, East Setauket, NY 11733 | 2016-07-08 |
| 1306258900 | Patricia M. Ferrara | Licensed Practical Nurse | 181 N Bellemeade Rd, Setauket, NY 11733 | 2014-05-30 |
| 1871922898 | Island Concierge Medical Services Pllc | Internal Medicine | 3400 Nesconset Hwy. Suite 103, East Setauket, NY 11733 | 2013-11-12 |
| 1669718219 | Sheila Marie Vergith | Physician Assistant | 17 Coraway Road, Setauket, NY 11733 | 2012-12-28 |
| 1285980474 | Jennifer L Monastero | Physical Therapist | 12 Technology Dr., Unit 2, E. Setauket, NY 11733 | 2012-07-25 |
| Find all providers in zip 11733 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255741153 | Harbor View Medical Services, P.C. | Surgery | 4 Technology Dr, Suite 120, East Setauket, NY 11733-4080 | 2014-04-30 |
| 1245415322 | Vascular Associates of Long Island, PC | Surgery | 4 Technology Dr, Suite 120, East Setauket, NY 11733-4068 | 2008-01-08 |
| 1689865347 | Andrea J Hendrzak | Surgery | 37 Research Way, East Setauket, NY 11733-3465 | 2007-08-07 |
| 1659459543 | Shang A. Loh | Surgery | 37 Research Way, East Setauket, NY 11733-3465 | 2006-11-01 |
| 1467471854 | Antonios Gasparis | Surgery | 37 Research Way, East Setauket, NY 11733 | 2006-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962003509 | Gs Medical, P.C. | Surgery | 377-b Pearsall Ave, Cedarhurst, NY 11516 | 2020-11-02 |
| 1073128971 | New York Vascular Group, Pllc | Surgery | 19 Laurel Ave Ste 102, Cornwall, NY 12518-1403 | 2020-09-09 |
| 1578190179 | Camilo Jose Martinez | Surgery | 23 S Howell Ave Ste H, Centereach, NY 11720-4445 | 2020-03-24 |
| 1407483399 | Interventional Medicine | Surgery | 1122a Coney Island Ave, Brooklyn, NY 11230-2307 | 2020-03-23 |
| 1487287975 | Syracuse Professional Medical Services of New York LLC | Surgery | 1101 Erie Blvd E Ste 201a, Syracuse, NY 13210-1144 | 2020-02-13 |
| 1457983181 | Syracuse Medical of New York LLC | Surgery | 1101 Erie Blvd E Ste 201b, Syracuse, NY 13210-1144 | 2020-02-11 |
| 1366914483 | Star Veins Centers PC | Surgery | 225 W 35th St Frnt 2, New York, NY 10001-1904 | 2018-12-31 |
| 1528547312 | Norwood Professional Medical Services of New York LLC | Surgery | 3487-89 Jerome Ave, Ste A, Bronx, NY 10468 | 2018-08-13 |
| 1336628130 | Norwood Medical of New York LLC | Surgery | 3487-89 Jerome Ave, Ste B, Bronx, NY 10468 | 2018-08-13 |
| 1003393299 | Bushwick Professional Medical Services of New York LLC | Surgery | 441 Knickerbocker Ave Ste A, Brooklyn, NY 11237-4508 | 2018-07-20 |
| Find all providers with the same taxonomy | ||||
| City | EAST SETAUKET |
| Zip Code | 11733 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.