Individual
MARIE-NIRVA BLAISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
760 GRAND CONCOURSE, BRONX, NY 10451-3049
(718) 518-5550
(718) 518-5111
Mailing address
653 LAWRENCE ST, ELMONT, NY 11003-4615
(516) 561-1318
(718) 401-2888
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
207405
NY
207RG0100X
Gastroenterology Physician
Primary
207405
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02809763
—
NY
01
—
207405
NYS LICENSE
NY
Enumeration date
10/11/2006
Last updated
02/11/2014
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