Provider Demographics
NPI:1457716110
Name:BLECK, NYEE
Entity Type:Individual
Prefix:
First Name:NYEE
Middle Name:
Last Name:BLECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 GILBERT PL
Mailing Address - Street 2:4
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912
Mailing Address - Country:US
Mailing Address - Phone:240-595-8607
Mailing Address - Fax:
Practice Address - Street 1:8714 GILBERT PL
Practice Address - Street 2:4
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7215
Practice Address - Country:US
Practice Address - Phone:240-595-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA00605967376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNA00605967Medicaid