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:
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Health care specialties

SpecialtyCodeLicense #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 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841358140 NPPES
New York MEDICAID 03848208

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