Provider Demographics
NPI:1649649757
Name:JOHN, BLESSEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:BLESSEN
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 14TH ST
Mailing Address - Street 2:APT 2D
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4648
Mailing Address - Country:US
Mailing Address - Phone:718-427-5688
Mailing Address - Fax:
Practice Address - Street 1:3365 14TH ST
Practice Address - Street 2:APT 2D
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4648
Practice Address - Country:US
Practice Address - Phone:718-427-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019089363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical