Provider Demographics
NPI:1194819896
Name:BLEICH, LAURIE (CNM)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:BLEICH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4922
Mailing Address - Country:US
Mailing Address - Phone:718-907-8100
Mailing Address - Fax:718-492-8614
Practice Address - Street 1:6317 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4922
Practice Address - Country:US
Practice Address - Phone:718-907-8100
Practice Address - Fax:718-492-8614
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000035367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife