Individual
DR. JASMINE MICHELLE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, MSPH
Contact information
Practice address
410 LAKEVILLE RD STE 108, NEW HYDE PARK, NY 11042-1102
(516) 465-4377
Mailing address
410 LAKEVILLE RD STE 108, NEW HYDE PARK, NY 11042-1102
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
326071
NY
208000000X
Pediatrics Physician
Primary
326071
NY
Other
Enumeration date
03/26/2020
Last updated
08/05/2024
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