Ellen Blank, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

25MA03293600 Issued in NY

Practice address

1122 Richmond Road
Staten Island, NY 10304

Phone

(718) 987-3300

Fax

(718) 987-3451

NPI assigned

Nov 16, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 30, 2015 through Jul 30, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: ellen.blank@direct.bayonnemedicalcenter.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hudson Richmond Dermatologym.D., P.a.

  • Dermatology Physician
  • Bayonne, NJ
  • NPI 1366795593
  NPD (past) Authorized official
• Ijkg Opco LLC

  • Skilled Nursing Facility
  • Bayonne, NJ
  • NPI 1437356755
  NPD
• Mitchell a. Schuman, MD,PC

  • Ophthalmology Physician
  • Staten Island, NY
  • NPI 1487972121
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033282900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 AVENUE C",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "07002",
            "telephone_number": "201-858-4800",
            "fax_number": "201-858-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 RICHMOND ROAD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10304",
            "telephone_number": "718-987-3300",
            "fax_number": "718-987-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANK",
        "first_name": "ELLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "25MA03293600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marie Anite Cassandra Blanchard
• Shalisa Bland
• Giovanna Blanda
• Sandra Blandon, NP
• Debora Blanford-Gaskin, CASAC-T
• Michael Andrew Blasco, M.D.
• Lorraine Susan Blasi Plaut, MSED
• Marrianne Blasso, PT
• Ilona Blaton, MPT
• Jonathan A Blau, M.D.

• Dermatology Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.