Provider Demographics
NPI:1205296696
Name:PETIT-FRERE, YVON
Entity type:Individual
Prefix:
First Name:YVON
Middle Name:
Last Name:PETIT-FRERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 GREAT NECK RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1922
Mailing Address - Country:US
Mailing Address - Phone:631-575-6737
Mailing Address - Fax:
Practice Address - Street 1:3512 GREAT NECK RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1922
Practice Address - Country:US
Practice Address - Phone:631-575-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator