Provider Demographics
NPI:1679084503
Name:O'CONNELL-BLATT, BIRGIT (RN)
Entity type:Individual
Prefix:
First Name:BIRGIT
Middle Name:
Last Name:O'CONNELL-BLATT
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 SUNSET LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-2847
Mailing Address - Country:US
Mailing Address - Phone:845-513-2012
Mailing Address - Fax:845-513-2177
Practice Address - Street 1:256 SUNSET LAKE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-2847
Practice Address - Country:US
Practice Address - Phone:845-513-2012
Practice Address - Fax:845-513-2177
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY490796-1364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care