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Contact Information

JESSICA L BLYDENBURGH, DO
125 OAKLAND AVE
PORT JEFFERSON, NY11777-2130
 Phone: 631-736-1311
 Fax: 631-736-1312
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for JESSICA L BLYDENBURGH · (Female)

NPI Number 1144548918
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 05/04/2010
Last updated 08/14/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 270049
Hospital affiliation(s)
  • JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON - (Acute Care)
    75 NORTH COUNTRY ROAD
    PORT JEFFERSON, NY 11777
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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