Maryellen Blank, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F400620-01 Issued in NY

Practice address

21 4TH Ave
Bay Shore, NY 11706-7908

Phone

(631) 665-6707

Fax

(631) 665-3564

NPI assigned

Dec 20, 2006

Last updated

Oct 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Catholic Charities of the Diocese of Rockville CentreGroup PAC ID 9436137908, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Catholic Charities of the Diocese of Rockville Centre

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bay Shore, NY
  • NPI 1124034558
  Medicare reassignment Care Compare group NPD
• The Long Island Home

  dba South Oaks Hospital

  • Psychiatric Hospital
  • Amityville, NY
  • NPI 1821394016
  Medicare reassignment NPD
• Catholic Charities of the Diocese of Rockville Centre

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Freeport, NY
  • NPI 1831110972
  NPD
• The Long Island Home

  dba South Oaks Hospital

  • Psychiatric Hospital
  • Amityville, NY
  • NPI 1568459204
  NPD

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1609930015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 DRIFTWOOD DR",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117955002",
            "telephone_number": "631-422-7362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 4TH AVE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067908",
            "telephone_number": "631-665-6707",
            "fax_number": "631-665-3564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANK",
        "first_name": "MARYELLEN",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F400620-01",
            "primary": true
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "NY",
            "license": "400620",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Blair, LMHC
• Anastasia Blanchard, NPP
• Edison Roque Blanco, M.D.
• Sophie Blanco, LMSW
• Jennifer Marie Blandino, LPN
• Brian Scott Blaustein, DO
• Nicklos Blaylock
• Matthew J. Blitz, M.D., M.B.A.
• Andrea Blom
• Bobs Optical Inc. (classy glasses)

• Psychiatric/Mental Health Nurse Practitioner in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.