Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 278978-1 | NY |
NPI | 1225472079 |
---|---|
Provider Name | Jennifer Kubo Blakemore |
First Address | New York, NY 10016-3295 |
Second Address | New York, NY 10016-3295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 17/10/2019 |