Individual
MIRIAM S BLAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N., P.N.P.
Contact information
Practice address
7 ISMAY ST, STATEN ISLAND, NY 10314-5019
(917) 744-1740
(718) 815-8122
Mailing address
7 ISMAY ST, STATEN ISLAND, NY 10314-5019
(917) 744-1740
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
520046-1
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
381940
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02460364
—
NY
Enumeration date
07/23/2007
Last updated
10/10/2019
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