Provider Demographics
NPI:1649321241
Name:BLOCK, EILEEN ELAINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:ELAINE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:EILEEN
Other - Middle Name:ELAINE
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:76 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2423
Mailing Address - Country:US
Mailing Address - Phone:518-885-5544
Mailing Address - Fax:518-885-7283
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2425
Practice Address - Country:US
Practice Address - Phone:518-243-4000
Practice Address - Fax:518-243-3258
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF352339-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU19939Medicare UPIN
NY55224BMedicare ID - Type Unspecified