Provider Demographics
NPI:1174031900
Name:FEDE, LOUIS SOLON JR (LPN)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:SOLON
Last Name:FEDE
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4926
Mailing Address - Country:US
Mailing Address - Phone:347-358-8481
Mailing Address - Fax:
Practice Address - Street 1:7 NEW YORK AVE # 25A
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3447
Practice Address - Country:US
Practice Address - Phone:631-724-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331212164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse