Provider Demographics
NPI:1124572680
Name:FERRETTI, MEGAN E (LAC, MSOM)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:E
Last Name:FERRETTI
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 ROUTE 25A
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2663
Mailing Address - Country:US
Mailing Address - Phone:516-480-3508
Mailing Address - Fax:
Practice Address - Street 1:565 ROUTE 25A
Practice Address - Street 2:SUITE 209
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2663
Practice Address - Country:US
Practice Address - Phone:516-480-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005713171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist