Healthcare Provider Details

I. General information

NPI: 1427204536
Provider Name (Legal Business Name): JILLIAN MARIE FRATEPIETRO RN, ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2008
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 RESEARCH WAY SUITE 500
EAST SETAUKET NY
11733-3487
US

IV. Provider business mailing address

HSC LEVEL T9 RM 040 UFPC SBUMC STONY BROOK UROLOGY
STONY BROOK NY
11794-8093
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-6270
  • Fax: 631-444-6552
Mailing address:
  • Phone: 631-444-1916
  • Fax: 631-444-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number521994
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number30305265
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: