Provider Demographics
NPI:1689003840
Name:FERRETTI, IVY B (LPN LICENSED PRACTIC)
Entity type:Individual
Prefix:MRS
First Name:IVY
Middle Name:B
Last Name:FERRETTI
Suffix:
Gender:F
Credentials:LPN LICENSED PRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5276
Mailing Address - Street 2:
Mailing Address - City:ROCKY PT
Mailing Address - State:NY
Mailing Address - Zip Code:11778
Mailing Address - Country:US
Mailing Address - Phone:631-476-3507
Mailing Address - Fax:
Practice Address - Street 1:830 CANAL RD
Practice Address - Street 2:
Practice Address - City:MT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766
Practice Address - Country:US
Practice Address - Phone:631-476-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251388-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse