Individual
KRISTEN BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1824 MADISON AVE, 5TH FLOOR, NEW YORK, NY 10035-3832
(212) 423-4500
Mailing address
1824 MADISON AVE, 5TH FLOOR, NEW YORK, NY 10035-3832
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA10267800
NJ
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/09/2014
Last updated
10/21/2024
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