Blaine, Debra Ellen
Blaine, Debra Ellen is an individual health care provider with primary practice located at 1912 E Jericho Trpk , East Northport NY 11731-1173. She recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as her primary health care specialty. Blaine, Debra Ellen can be contacted via phone (631) 238-3065.Contact Information
Primary practice address
1912 E Jericho Trpk
East Northport NY 11731-1173
Phone: (631) 238-3065
Fax: (631) 443-4625
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | 179846 | New York |
Profile Details
| NPI number | 1841358140 |
|---|---|
| LBN Legal business name | Blaine, Debra Ellen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 5th, 2006 |
| Last updated | Apr 13th, 2018 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841358140 | NPPES |
| New York | MEDICAID | 03848208 |
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