1871564005 NPI number — DR. ROBIN L BLISS MD

Table of content: DR. ROBIN L BLISS MD (NPI 1871564005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871564005 NPI number — DR. ROBIN L BLISS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLISS
Provider First Name:
ROBIN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1871564005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
267 E MAIN ST
Provider Second Line Business Mailing Address:
BLDG C
Provider Business Mailing Address City Name:
SMITHTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11787-2874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-724-8585
Provider Business Mailing Address Fax Number:
631-265-1528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MOTOR PKWY
Provider Second Line Business Practice Location Address:
SUITE D22
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-435-4322
Provider Business Practice Location Address Fax Number:
631-435-3423
Provider Enumeration Date:
01/27/2006

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: 207V00000X , with the licence number:  181368 , 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)





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