Healthcare Provider Details

I. General information

NPI: 1215374665
Provider Name (Legal Business Name): LINDSEY FREKING PMHNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date: 06/21/2022
Reactivation Date: 07/19/2022

III. Provider practice location address

2539 MIDDLE COUNTRY RD
CENTEREACH NY
11720-3551
US

IV. Provider business mailing address

51 E MADISON ST
EAST ISLIP NY
11730-1605
US

V. Phone/Fax

Practice location:
  • Phone: 631-737-6434
  • Fax: 631-738-1226
Mailing address:
  • Phone: 631-338-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF404408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: