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General NPI Number Information
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NPI Number | 1629998885
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE CARE
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Dates
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Enumeration Date | 07/17/2026
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Last Update Date | 07/17/2026
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Provider Practice Location Address
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Address Line | 1797 VETERANS MEMORIAL HWY
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City | ISLANDIA
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State | NY
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Zip | 11749-1537
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Country | US
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Telephone | 631-838-5320
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Fax |
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Provider Business Mailing Address
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Address Line | 221 JAYNE BLVD
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2905
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Country | US
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Telephone | 631-838-5320
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | EHSAN BUTT
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Credential |
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Telephone | 631-838-5320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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