Individual provider Active NPI

Annamarie Goldblatt, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Coram, NY
National Provider Identifier
1427384635
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F400391-1 Issued in NY
Practice address
3600 Route 112
Coram, NY 11727-4116
Phone
(631) 920-8500
NPI assigned
Oct 22, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Family Psychiatric/Mental Health Clinical Nurse Specialist 364SP0810X F400391-1 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F400391-1 NY Primary

Addresses

Primary practice location

3600 Route 112
Coram, NY 11727-4116

Mailing address

140 E Main St Ste 4
Huntington, NY 11743-2844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20150206000658 NY Practitioner - Nurse Practitioner 7416272844 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 1995
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Welllife Network IncGroup PAC ID 0749179570, 17 clinicians

Practice addresses (Care Compare)

3600 Route 112
Coram, NY 11727-4116
Phone (631) 920-8302

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F400391-1NYMDChild & Family Psychiatric/Mental Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Welllife Network Inc CurrentSince Nov 12, 2025 Accepting new patients
Welllife Network Inc., Current Accepting new patients
Welllife Network Inc. CurrentSince Nov 12, 2025 Accepting new patients

Locations

3600 Route 112
Coram, NY 11727
Phone (631) 854-2100

14202 20th Ave
Fl 3
Flushing, NY 11351
Phone (718) 559-0516

800 Northern Blvd
Great Neck, NY 11021
Phone (516) 829-8450

55 Horizon Dr
Huntington, NY 11743
Phone (631) 396-2300

11 Route 111
Smithtown, NY 11787
Phone (631) 920-8300

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752105600000",
    "number": "1427384635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 E MAIN ST STE 4",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117432844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 ROUTE 112",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117274116",
            "telephone_number": "631-920-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBLATT",
        "first_name": "ANNAMARIE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-22",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0810X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Family",
            "state": "NY",
            "license": "F400391-1",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F400391-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coram, NY

Sources for this page

Verify at the official NPI Registry.