Healthcare Provider Details

I. General information

NPI: 1265638498
Provider Name (Legal Business Name): TONI AGNES FERELLO R.N.BSN,HCQM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MIDHAMPTON CT. E. QUOGUE
LONG ISLAND NY
11959
US

IV. Provider business mailing address

154 VILLAGE DR
HAUPPAUGE NY
11788-3228
US

V. Phone/Fax

Practice location:
  • Phone: 631-653-9605
  • Fax:
Mailing address:
  • Phone: 631-979-3425
  • Fax: 631-979-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number394292-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: