Healthcare Provider Details

I. General information

NPI: 1386922417
Provider Name (Legal Business Name): NANICE E REGIS BLAY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E 75TH ST
NEW YORK NY
10021-2706
US

IV. Provider business mailing address

57 E 75TH ST
NEW YORK NY
10021-2706
US

V. Phone/Fax

Practice location:
  • Phone: 212-472-3100
  • Fax:
Mailing address:
  • Phone: 212-472-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number055504-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: