Provider Demographics
NPI:1306144605
Name:BLASSBERG-MILICH, ADRIENNE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:
Last Name:BLASSBERG-MILICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LINK CT
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1623
Mailing Address - Country:US
Mailing Address - Phone:845-608-7559
Mailing Address - Fax:203-304-1048
Practice Address - Street 1:9 LINK CT
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1623
Practice Address - Country:US
Practice Address - Phone:845-608-7559
Practice Address - Fax:203-304-1048
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332822-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily