Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 152716-1 | NY |
N | 207VG0400X | Gynecologist | 152716-1 | NY |
NPI | 1780603191 |
---|---|
Provider Name | Jody Blanco |
First Address | New York, NY 10032-3720 |
Second Address | New York, NY 10032-3729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 15/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B79893 | (02) | NY |