Healthcare Provider Details

I. General information

NPI: 1629203096
Provider Name (Legal Business Name): KECIA-ANN MAY BLISSETT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5589
US

IV. Provider business mailing address

50 WATER ST FL 2ND
NEW YORK NY
10004-6001
US

V. Phone/Fax

Practice location:
  • Phone: 646-265-7295
  • Fax:
Mailing address:
  • Phone: 973-489-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number275202
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number275202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: