Individual
DR. MICHAEL LAURENCE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 RIVER AVE, LAKEWOOD, NJ 08701-5237
(732) 942-5721
(732) 942-5723
Mailing address
600 RIVER AVE, LAKEWOOD, NJ 08701-5237
(732) 942-5721
(732) 942-5723
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA08599800
NJ
Other
Enumeration date
07/18/2008
Last updated
03/08/2011
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