Provider Demographics
NPI:1972755288
Name:DEBLASI, LISA JILL (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JILL
Last Name:DEBLASI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WOOD HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2735
Mailing Address - Country:US
Mailing Address - Phone:631-269-4294
Mailing Address - Fax:
Practice Address - Street 1:100 HAUPPAUGE RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4403
Practice Address - Country:US
Practice Address - Phone:631-499-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390006-1163W00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse