Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 25MB11178700 | NJ |
NPI | 1770978025 |
---|---|
Provider Name | Conor H. Blanco |
First Address | Berkeley Heights, NJ 07922-2104 |
Second Address | Westfield, NJ 07090-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 30/09/2021 |