Individual
BLECK EXILUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14-20 MACDADE BLVD STE A, DARBY, PA 19023-1822
(610) 522-4506
Mailing address
14-20 MACDADE BLVD STE A, DARBY, PA 19023-1822
(610) 522-4506
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP031538
PA
Other
Enumeration date
12/04/2024
Last updated
12/04/2024
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