Provider Demographics
NPI:1245660273
Name:O'NEILL, LANA (NP)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:
Other - Last Name:BLIDNAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:65 BROADWAY STE 1804
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2560
Mailing Address - Country:US
Mailing Address - Phone:212-430-6677
Mailing Address - Fax:212-430-6678
Practice Address - Street 1:999 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3535
Practice Address - Country:US
Practice Address - Phone:718-277-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338297-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03970207Medicaid