Provider Demographics
NPI:1194868208
Name:NADFRED CORP.
Entity Type:Organization
Organization Name:NADFRED CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-979-8732
Mailing Address - Street 1:185 OLD WILLETS PATH
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4105
Mailing Address - Country:US
Mailing Address - Phone:631-979-8732
Mailing Address - Fax:631-360-2692
Practice Address - Street 1:185 OLD WILLETS PATH
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4105
Practice Address - Country:US
Practice Address - Phone:631-979-8732
Practice Address - Fax:631-360-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012622261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012622OtherLICENSE NUMBER