Individual
MR. DARYLE MARC BLACKSTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
622 W 168TH ST, PH 14, RM 104, NEW YORK, NY 10032-3720
(212) 305-7771
(212) 342-5307
Mailing address
622 W 168TH ST, PH 14, RM 104, NEW YORK, NY 10032-3720
(212) 305-7771
(212) 342-5307
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006279-1
NY
Other
Enumeration date
10/04/2006
Last updated
07/15/2015
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