1558794354 NPI number — BLESSIOS MEDICAL

Table of content: (NPI 1558794354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558794354 NPI number — BLESSIOS MEDICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLESSIOS MEDICAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558794354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 COLLEGE PKWY STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-6880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-822-2400
Provider Business Mailing Address Fax Number:
716-822-2424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COLLEGE PKWY STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-6880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-822-2400
Provider Business Practice Location Address Fax Number:
716-822-2424
Provider Enumeration Date:
08/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BLESSIOS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
716-822-2400

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  219980 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000526338001 . This is a "BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QMP005565 . This is a "MARTINS POINT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426002483 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02162334 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00025531801 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1711188 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9511513 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0240049862 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 219980-0-OB . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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