Individual provider Active NPI

Lisa Blaszczyk, CRNP

  • Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1043030471
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN703832 Issued in PA
Practice address
9815 Roosevelt Blvd
Philadelphia, PA 19114-1035
Phone
(215) 969-4917
NPI assigned
Oct 11, 2024
Last updated
Oct 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN703832 PA Primary

Addresses

Primary practice location

9815 Roosevelt Blvd
Philadelphia, PA 19114-1035

Mailing address

PO Box 13579
Reading, PA 19612-3579
Phone (484) 628-1324

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241119002883 PA Practitioner - Nurse Practitioner 6305371980 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN703832PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
STC Pediatrics LLC Current Accepting new patients
STC Pediatrics LLC CurrentSince Jan 1, 2025 Accepting new patients
STC Pediatrics LLC CurrentSince Jan 1, 2025 Accepting new patients
STC Pediatrics LLC Past Accepting new patients

Locations

300 E Hunting Park Ave
Philadelphia, PA 19124
Phone (215) 427-8363

9815 Roosevelt Blvd
Philadelphia, PA 19114
Phone (215) 333-9697

9815 Roosevelt Blvd
Ste N
Philadelphia, PA 19114

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1728604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1043030471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13579",
            "city": "READING",
            "state": "PA",
            "postal_code": "196123579",
            "telephone_number": "484-628-1324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9815 ROOSEVELT BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141035",
            "telephone_number": "215-969-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLASZCZYK",
        "first_name": "LISA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-11",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "RN703832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.