Provider Demographics
NPI:1528139656
Name:FRITH, JANE DARYL (JANE FRITH,NPP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:DARYL
Last Name:FRITH
Suffix:
Gender:F
Credentials:JANE FRITH,NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:BRIDGEHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11932-0804
Mailing Address - Country:US
Mailing Address - Phone:631-338-4433
Mailing Address - Fax:631-725-2899
Practice Address - Street 1:12 CORWIN HOUSE, FIRST ST.
Practice Address - Street 2:UNIT 3
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-338-4433
Practice Address - Fax:631-725-2899
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400678-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2E7991Medicare UPIN