Provider Demographics
NPI:1942643309
Name:PARRISH, FRED J (LPN)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:J
Last Name:PARRISH
Suffix:
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 1:177 ARTIST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2315
Mailing Address - Country:US
Mailing Address - Phone:631-512-8780
Mailing Address - Fax:631-775-8497
Practice Address - Street 1:177 ARTIST LAKE DR
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2315
Practice Address - Country:US
Practice Address - Phone:631-512-8780
Practice Address - Fax:631-775-8497
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312049-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse