Individual
MRS. BENITA FREDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
49 CHURCH ST, FREEPORT, NY 11520-3830
(516) 623-6253
Mailing address
2856 CLARK AVE, OCEANSIDE, NY 11572-1905
(516) 594-2191
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
006435-1
NY
Other
Enumeration date
08/02/2006
Last updated
07/08/2007
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