Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00263900 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00263900 | NJ |
N | 111NR0200X | Radiology | 25MD002639 | NJ |
N | 213ER0200X | Radiology | 25MD002639 | NJ |
N | 2081S0010X | Sports Medicine | 25MD00263900 | NJ |
N | 213ES0000X | Sports Medicine | 25MD00263900 | NJ |
N | 213ES0103X | Foot & Ankle Surgery | 25MD00262900 | NJ |
NPI | 1194799239 |
---|---|
Provider Name | Dr. Christopher H Blakeslee |
First Address | Jackson, NJ 08527-3435 |
Second Address | Jackson, NJ 08527-3435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 01/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9052801 | (05) | NJ |
U84601 | (02) |