Healthcare Provider Details

I. General information

NPI: 1528093978
Provider Name (Legal Business Name): GLORIA J BLOCK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 HOOPER RD ENDWELL FAMILY PHYSICIANS LLP
ENDWELL NY
13760-3698
US

IV. Provider business mailing address

415 HOOPER RD
ENDWELL NY
13760-3698
US

V. Phone/Fax

Practice location:
  • Phone: 607-754-3863
  • Fax: 607-754-5697
Mailing address:
  • Phone: 607-754-3863
  • Fax: 607-754-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number330385
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: