Healthcare Provider Details

I. General information

NPI: 1295013092
Provider Name (Legal Business Name): LEANNE FERRETTI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ROANOKE AVE
RIVERHEAD NY
11901-2031
US

IV. Provider business mailing address

75 N COUNTRY RD
PORT JEFFERSON NY
11777-2190
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2478
  • Fax:
Mailing address:
  • Phone: 631-476-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014937
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: