Healthcare Provider Details

I. General information

NPI: 1780884205
Provider Name (Legal Business Name): MIRIAM S BLAU R.N., P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ISMAY ST
STATEN ISLAND NY
10314-5019
US

IV. Provider business mailing address

7 ISMAY ST
STATEN ISLAND NY
10314-5019
US

V. Phone/Fax

Practice location:
  • Phone: 917-744-1740
  • Fax: 718-815-8122
Mailing address:
  • Phone: 917-744-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number520046-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number381940
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: