Basic Information
| Provider Information | |||||||||
| NPI: | 1598205205 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BLUM | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1978 CROMPOND ROAD | ||||||||
| Address2: | CAREMOUNT MEDICAL PC | ||||||||
| City: | CORTLANDT MANOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147392121 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 S. BEDFORD ROAD | ||||||||
| Address2: | CAREMOUNT MEDICAL PC | ||||||||
| City: | MT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2017 | ||||||||
| LastUpdateDate: | 02/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 307567 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.