Provider Demographics
NPI:1851042188
Name:BLEICH, LILA MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:LILA
Middle Name:MICHELLE
Last Name:BLEICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2720
Mailing Address - Country:US
Mailing Address - Phone:516-974-4881
Mailing Address - Fax:
Practice Address - Street 1:181 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1907
Practice Address - Country:US
Practice Address - Phone:516-248-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349094363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily