Healthcare Provider Details

I. General information

NPI: 1063300010
Provider Name (Legal Business Name): FREDERICA A WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BETHPAGE RD
PLAINVIEW NY
11803-4228
US

IV. Provider business mailing address

16220 TUSKEGEE AIRMEN WAY
JAMAICA NY
11433-1608
US

V. Phone/Fax

Practice location:
  • Phone: 516-731-5588
  • Fax:
Mailing address:
  • Phone: 718-791-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: