Healthcare Provider Details

I. General information

NPI: 1578080446
Provider Name (Legal Business Name): ILYSE B FEBBRARO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 10/21/2026
Certification Date: 10/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 W MAIN ST
PATCHOGUE NY
11772-3002
US

IV. Provider business mailing address

44 W MAIN ST
PATCHOGUE NY
11772-3002
US

V. Phone/Fax

Practice location:
  • Phone: 631-359-3670
  • Fax: 631-268-2076
Mailing address:
  • Phone: 631-359-3670
  • Fax: 631-268-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342024-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: