Healthcare Provider Details

I. General information

NPI: 1679481253
Provider Name (Legal Business Name): ERMITA PETIT FRERE PETIT-FRERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 BLUE POINT AVE
BLUE POINT NY
11715-1261
US

IV. Provider business mailing address

540 DONEGAN AVE
EAST PATCHOGUE NY
11772-5107
US

V. Phone/Fax

Practice location:
  • Phone: 631-363-5794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: