Individual
DR. JERRY GENE BLAIVAS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
445 E 77TH ST, NEW YORK, NY 10021-2318
(212) 772-3900
(212) 772-1919
Mailing address
445 E 77TH ST, NEW YORK, NY 10021-2318
(212) 772-3900
(212) 772-1919
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
144945 1
NY
Other
Enumeration date
06/12/2006
Last updated
07/08/2007
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