Provider Demographics
NPI:1588488522
Name:BLISS HOSACK, AYNALEM SARAH
Entity type:Individual
Prefix:
First Name:AYNALEM
Middle Name:SARAH
Last Name:BLISS HOSACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5643 MOSHOLU AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2429
Mailing Address - Country:US
Mailing Address - Phone:347-229-5169
Mailing Address - Fax:
Practice Address - Street 1:424 E 147TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4104
Practice Address - Country:US
Practice Address - Phone:212-553-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY933671163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse