=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558794354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLESSIOS MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2013
-----------------------------------------------------
Last Update Date | 05/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 COLLEGE PKWY STE 120
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-6880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-822-2400
-----------------------------------------------------
Fax | 716-822-2424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 COLLEGE PKWY STE 120
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-6880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-822-2400
-----------------------------------------------------
Fax | 716-822-2424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | GEORGE A BLESSIOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-822-2400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 219980
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------