Basic Information
Provider Information
NPI: 1043483951
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREYTSIS
FirstName: MARIA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 760 BROADWAY DEPARTMENT OF MANAGED CARE ROOM 2B230
Address2: WOODHULL MEDICAL & MENTAL HEALTH CENTER
City: BROOKLYN
State: NY
PostalCode: 11206
CountryCode: US
TelephoneNumber: 7189638000
FaxNumber: 7186303122
Practice Location
Address1: 760 BROADWAY
Address2: WOODHULL MEDICAL & MENTAL HEALTH CENTER
City: BROOKLYN
State: NY
PostalCode: 11206
CountryCode: US
TelephoneNumber: 7189638000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/11/2008
LastUpdateDate: 07/18/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X001305NYY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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