Individual
EMMA BLACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
875 ELLICOTT ST, BUFFALO, NY 14203-1070
(716) 748-2100
Mailing address
697 EAST AVE, LOCKPORT, NY 14094-3303
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
020869
NY
Other
Enumeration date
06/28/2017
Last updated
06/28/2017
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