Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 275445 | NY |
NPI | 1518308758 |
---|---|
Provider Name | Dr. Stasia Blyskal |
First Address | Brooklyn, NY 11201-4421 |
Second Address | Brooklyn, NY 11201-4421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2013 |
Last Update Date | 22/03/2021 |