Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 139397 | NY |
NPI | 1023113339 |
---|---|
Provider Name | Mr. Joseph Anthony Blanco |
First Address | Manhasset, NY 11030 |
Second Address | Manhasset, NY 11030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 21/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0709499 | (05) | NY |
B73536 | (02) |