Individual
DANIELLE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
741 NORTHFIELD AVE STE 104, WEST ORANGE, NJ 07052-1104
(973) 243-1486
Mailing address
741 NORTHFIELD AVE STE 104, WEST ORANGE, NJ 07052-1104
(973) 243-0600
(973) 243-0707
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA10613900
NJ
Other
Enumeration date
06/14/2014
Last updated
12/16/2019
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