Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 184696 | NY |
NPI | 1346371747 |
---|---|
Provider Name | Dr. Emily Jane Blake |
First Address | Nyack, NY 10960-1615 |
Second Address | Nyack, NY 10960-1615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |