Healthcare Provider Details

I. General information

NPI: 1295362895
Provider Name (Legal Business Name): ROSELLE READ BLECK MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST PH 16-69
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST PH 16-69
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-9368
  • Fax:
Mailing address:
  • Phone: 212-305-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VC0300X
TaxonomyComplex Family Planning Physician
License Number328111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: