Provider Demographics
NPI:1033896840
Name:BLAIR, ROBERT (PMHNP, RN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BLAIR
Suffix:
Gender:M
Credentials:PMHNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1939
Mailing Address - Country:US
Mailing Address - Phone:516-698-3026
Mailing Address - Fax:
Practice Address - Street 1:5100 SUNRISE HWY FL 2
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2935
Practice Address - Country:US
Practice Address - Phone:516-715-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405139363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health