Provider Demographics
NPI:1962794735
Name:BLOCH, JOAN ROSEN (CRNP)
Entity type:Individual
Prefix:PROF
First Name:JOAN
Middle Name:ROSEN
Last Name:BLOCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N 15TH STREET
Mailing Address - Street 2:MAIL STOP 1030
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102
Mailing Address - Country:US
Mailing Address - Phone:215-254-2599
Mailing Address - Fax:
Practice Address - Street 1:2230 COTTMAN AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1230
Practice Address - Country:US
Practice Address - Phone:215-254-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004635G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology