Provider Demographics
NPI:1760677397
Name:BLASETTI, EILEEN THERESA (RN)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:THERESA
Last Name:BLASETTI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:NY
Mailing Address - Zip Code:10511
Mailing Address - Country:US
Mailing Address - Phone:914-930-1400
Mailing Address - Fax:
Practice Address - Street 1:231 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:NY
Practice Address - Zip Code:10511
Practice Address - Country:US
Practice Address - Phone:914-930-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406942163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01667472Medicaid