=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841342482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BLANCHE MARJORIE CARNEY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 09/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 W 84TH ST ROOM 115
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10024-4614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-441-5656
-----------------------------------------------------
Fax | 917-441-5787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 E END AVE 6F
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-7928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-249-3761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | F380154-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------