Provider Demographics
NPI:1053694711
Name:BLAS, ZORAIDA (PA)
Entity type:Individual
Prefix:MS
First Name:ZORAIDA
Middle Name:
Last Name:BLAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 93RD ST
Mailing Address - Street 2:APT 31E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3966
Mailing Address - Country:US
Mailing Address - Phone:917-538-1392
Mailing Address - Fax:
Practice Address - Street 1:245 E 93RD ST
Practice Address - Street 2:APT 31E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3966
Practice Address - Country:US
Practice Address - Phone:917-538-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004105-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant