Provider Demographics
NPI:1265638498
Name:FERELLO, TONI AGNES (RNBSN,HCQM)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:AGNES
Last Name:FERELLO
Suffix:
Gender:F
Credentials:RNBSN,HCQM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3228
Mailing Address - Country:US
Mailing Address - Phone:631-979-3425
Mailing Address - Fax:631-979-3425
Practice Address - Street 1:7 MIDHAMPTON CT.
Practice Address - Street 2:E. QUOGUE
Practice Address - City:LONG ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11959
Practice Address - Country:US
Practice Address - Phone:631-653-9605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY394292-1163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine