Individual
ELLEN BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1122 RICHMOND ROAD, STATEN ISLAND, NY 10304
(718) 987-3300
(718) 987-3451
Mailing address
333 AVENUE C, BAYONNE, NJ 07002
(201) 858-4800
(201) 858-3005
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
25MA03293600
NY
Other
Enumeration date
11/16/2006
Last updated
07/08/2007
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