Individual
BLAKE HOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-8440
Mailing address
111 E 210TH ST, BRONX, NY 10467-2401
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
017122
NY
Other
Enumeration date
11/01/2013
Last updated
11/01/2013
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