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Individual
ROBERT DEMAREST BLAKE JR.
Active
Individual
ROBERT DEMAREST BLAKE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
251326-1
NY
311ZA0620X
Adult Care Home Facility
251326-1
NY
Other
Enumeration date
04/06/2015
Last updated
04/06/2015
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