Healthcare Provider Details

I. General information

NPI: 1336597103
Provider Name (Legal Business Name): BLESSAN THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 NEW YORK AVE STE B
HUNTINGTON STATION NY
11746-4212
US

IV. Provider business mailing address

2375 NEW YORK AVE STE B
HUNTINGTON STATION NY
11746-4212
US

V. Phone/Fax

Practice location:
  • Phone: 516-952-6242
  • Fax:
Mailing address:
  • Phone: 516-952-6242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT211715
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number301468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: