Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | MD002662 | NJ |
NPI | 1093880478 |
---|---|
Provider Name | Elena Blanco |
First Address | Hackensack, NJ 07601-2233 |
Second Address | Hackensack, NJ 07601-2233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 07/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U94289 | (02) |