Ms Maryellen Blank, NP is a medicare enrolled "Clinical Nurse Specialist - Psychiatric/mental Health, Adult" in West Islip, New York. Her current practice location is
170 Driftwood Dr, West Islip, New York. You can reach out to her office (for appointments etc.) via phone at
(631) 422-7362.
Ms Maryellen Blank is licensed to practice in New York (license number 400620) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1609930015.
Provider's Profile
Full Name | Ms Maryellen Blank |
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Gender | Female |
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Speciality | Clinical Nurse Specialist - Psychiatric/mental Health, Adult |
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Location | 170 Driftwood Dr, West Islip, New York |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1609930015
- Provider Enumeration Date: 12/20/2006
- Last Update Date: 02/10/2022
Medicare PECOS Information:
- PECOS PAC ID: 1759609688
- Enrollment ID: I20150406000602
Medical Identifiers
Medical identifiers for Ms Maryellen Blank such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1609930015 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
364SP0809X | Clinical Nurse Specialist - Psychiatric/mental Health, Adult | 400620 (New York) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Ms Maryellen Blank allows following entities to bill medicare on her behalf.
Entity Name | Catholic Charities Of The Diocese Of Rockville Centre |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1124034558 PECOS PAC ID: 9436137908 Enrollment ID: O20040721000332 |
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Entity Name | The Long Island Home |
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Entity Type | Part B Supplier - Hospital Department(s) |
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Entity Identifiers | NPI Number: 1821394016 PECOS PAC ID: 8224055108 Enrollment ID: O20110411000230 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Maryellen Blank is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Ms Maryellen Blank, NP 170 Driftwood Dr, West Islip, NY 11795-5002 Ph: (631) 422-7362 | Ms Maryellen Blank, NP 170 Driftwood Dr, West Islip, NY 11795-5002 Ph: (631) 422-7362 |
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