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General NPI Number Information
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NPI Number | 1467696658
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Entity Type | Individual
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Provider Name | FREDDY NUNEZ PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 05/01/2009
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Provider Practice Location Address
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Address Line | 8 MAPLE AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-8722
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Country | US
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Telephone | 631-665-4392
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Fax |
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Provider Business Mailing Address
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Address Line | 340 S 3RD ST APT A2
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City | BROOKLYN
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State | NY
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Zip | 11211-6347
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Country | US
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Telephone | 347-451-6727
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 013116
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License Number State | NY
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