Blank, Maryellen

Blank, Maryellen is an sole proprietor health care provider with primary practice located at 21 4Th Ave , Bay Shore NY 11706-7908. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Adult, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Blank, Maryellen can be contacted via phone (631) 665-6707.

Contact Information

Primary practice address
21 4Th Ave Bay Shore NY 11706-7908
Phone: (631) 665-6707
Fax: (631) 665-3564
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Adult 364SP0809X 400620 New York
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X F400620-01 New York

Profile Details

NPI number 1609930015
LBN Legal business name Blank, Maryellen
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 20th, 2006
Last updated Oct 17th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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