Healthcare Provider Details

I. General information

NPI: 1528812211
Provider Name (Legal Business Name): TERESA BLASSCYK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5034 ATLANTIC AVE
MAYS LANDING NJ
08330-2022
US

IV. Provider business mailing address

2201 RENAISSANCE BLVD
KING OF PRUSSIA PA
19406-2709
US

V. Phone/Fax

Practice location:
  • Phone: 609-782-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR22916300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: