Organization
BLUE RIDGE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLE ROSA CRNP (OWNER)
(607) 237-1209
Entity
Organization
Contact information
Practice address
433 CHURCH ST, NEW MILFORD, PA 18834-6603
(570) 465-4500
(570) 465-4501
Mailing address
433 CHURCH ST, P.O. BOX 602, NEW MILFORD, PA 18834-6603
(570) 465-4500
(570) 465-4501
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
BM2828929
PA
363LF0000X
Family Nurse Practitioner
Primary
SP009050
PA
Other
Enumeration date
10/25/2012
Last updated
10/25/2012
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