Healthcare Provider Details

I. General information

NPI: 1972878940
Provider Name (Legal Business Name): JOAN TRETTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 ARTHUR AVE
BRONX NY
10457-6306
US

IV. Provider business mailing address

1 CONSULATE DR APT 2L
TUCKAHOE NY
10707-2410
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-6853
  • Fax:
Mailing address:
  • Phone: 914-202-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number327690
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: