Individual
LARRY BLACKMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
121 DEKALB AVE, BROOKLYN, NY 11201-5425
(718) 250-8444
Mailing address
121 DEKALB AVE, BROOKLYN, NY 11201-5425
(718) 250-8444
Taxonomy
Speciality
Code
Description
License number
State
281P00000X
Chronic Disease Hospital
Primary
007277
NY
Other
Enumeration date
02/02/2009
Last updated
02/02/2009
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