Individual
MRS. AMY JO BLACKFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
15 S PINE AVE, ALBANY, NY 12208-2212
(518) 369-7398
(518) 446-0543
Mailing address
15 S PINE AVE, ALBANY, NY 12208-2212
(518) 369-7398
(518) 446-0543
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
676645961
NY
171W00000X
Contractor
Primary
676646961
NY
Other
Enumeration date
10/21/2008
Last updated
10/21/2008
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