Provider Demographics
NPI:1124429352
Name:DUBAS FRIED, NATALIE (RN)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:DUBAS FRIED
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4012
Mailing Address - Country:US
Mailing Address - Phone:631-894-2405
Mailing Address - Fax:
Practice Address - Street 1:1407 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4012
Practice Address - Country:US
Practice Address - Phone:631-894-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688574163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse