Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 240409 | NY |
NPI | 1104074244 |
---|---|
Provider Name | Dr. Irene Blanco |
First Address | Cliffside Park, NJ 07010-3236 |
Second Address | Bronx, NY 10461-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 03/09/2008 |