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General NPI Number Information
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NPI Number | 1851042188
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Entity Type | Individual
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Provider Name | LILA MICHELLE BLEICH FNP
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Gender | Female
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 181 OLD COUNTRY RD
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City | CARLE PLACE
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State | NY
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Zip | 11514-1907
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Country | US
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Telephone | 516-248-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 360 ROOSEVELT BLVD
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-2720
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Country | US
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Telephone | 516-974-4881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 349094
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License Number State | NY
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