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General NPI Number Information
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NPI Number | 1306577960
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Entity Type | Organization
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Legal Business Name | BLUE STONE WELLNESS LLC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 7710 NW 71ST COURT, TAMARAC, FL 33321 SUITE 305
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City | TAMARAC
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State | FL
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Zip | 33321
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Country | US
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Telephone | 754-205-7619
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Fax |
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Provider Business Mailing Address
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Address Line | 7710 NW 71ST COURT, TAMARAC, FL 33321 SUITE 101
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City | TAMARAC
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State | FL
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Zip | 33321
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Country | US
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Telephone | 754-205-7619
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JAIME K. BLAUSTEIN
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Credential |
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Telephone | 201-704-0929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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