Healthcare Provider Details

I. General information

NPI: 1447358239
Provider Name (Legal Business Name): JUDITH R EHRENFELD PHD RN CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 OAKFIELD AVENUE
FREEPORT NY
11520-1936
US

IV. Provider business mailing address

42 OAKFIELD AVENUE
FREEPORT NY
11520-1936
US

V. Phone/Fax

Practice location:
  • Phone: 516-623-7081
  • Fax: 516-623-7596
Mailing address:
  • Phone: 516-623-7081
  • Fax: 516-623-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1817321
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number1817321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: