1568718369 NPI number — KATHERINE E BLOSS NP

Table of content: MS. RUTH SOLOMON TUPPER RN (NPI 1295106573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568718369 NPI number — KATHERINE E BLOSS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOSS
Provider First Name:
KATHERINE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANTORO
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568718369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 4164
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-323-7175
Provider Business Mailing Address Fax Number:
866-867-4172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 CRYSTAL RUN RD
Provider Second Line Business Practice Location Address:
STE 135
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10941-7009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-333-7575
Provider Business Practice Location Address Fax Number:
845-333-7139
Provider Enumeration Date:
07/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  617533-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 337559 , 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: 03497972 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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