Provider Demographics
NPI:1598205205
Name:BLUM, TRACEY A
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:A
Last Name:BLUM
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 1:1978 CROMPOND ROAD
Mailing Address - Street 2:CAREMOUNT MEDICAL PC
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-739-2121
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:110 S. BEDFORD ROAD
Practice Address - Street 2:CAREMOUNT MEDICAL PC
Practice Address - City:MT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-242-1516
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner