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General NPI Number Information
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NPI Number | 1275482838
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Entity Type | Individual
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Provider Name | MR. PETER DAVID FETIAK JR.
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Gender | Male
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 80 MAPLE AVE STE 201
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City | SMITHTOWN
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State | NY
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Zip | 11787-3520
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Country | US
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Telephone | 631-306-4284
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Fax |
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Provider Business Mailing Address
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Address Line | 2 TREE CT
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City | EAST SETAUKET
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State | NY
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Zip | 11733-1015
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Country | US
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Telephone | 631-689-8441
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 05-P127291-01
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License Number State | NY
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