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NPI Code Detail

MEDICARE: ELLEN BLYE M.D.

MEDICARE: ELLEN BLYE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician141907NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750451845
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN BLYE M.D.
Provider Business Mailing Address
First Line : 123 W 86TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10024-3419
Country : US
Telephone Number : 212-877-2833
Fax Number : 212-362-7080
Provider Business Practice Location Address
First Line : 123 W 86TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10024-3419
Country : US
Telephone Number : 212-877-2833
Fax Number : 212-362-7080
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 08/30/2020

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