Provider Demographics
NPI:1508166182
Name:TEJANO, BLISS SHARON S
Entity Type:Individual
Prefix:
First Name:BLISS SHARON
Middle Name:S
Last Name:TEJANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 JACKSON AVE
Mailing Address - Street 2:MINEOLA
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2459
Mailing Address - Country:US
Mailing Address - Phone:212-481-8678
Mailing Address - Fax:212-481-6398
Practice Address - Street 1:303 5TH AVE
Practice Address - Street 2:SUITE 1413
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6601
Practice Address - Country:US
Practice Address - Phone:212-481-8678
Practice Address - Fax:212-481-6398
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist