Provider Demographics
NPI:1356743157
Name:FERERE, JOVANI
Entity type:Individual
Prefix:
First Name:JOVANI
Middle Name:
Last Name:FERERE
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 1:8 N BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1916
Mailing Address - Country:US
Mailing Address - Phone:516-710-3343
Mailing Address - Fax:
Practice Address - Street 1:8 N BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1916
Practice Address - Country:US
Practice Address - Phone:516-710-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317440-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse