Organization
ALEX D BLANCO, DPM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEX D BLANCO (OWNER)
(973) 941-3769
Entity
Organization
Contact information
Practice address
180 LAFAYETTE AVE, APT. 12A, PASSAIC, NJ 07055-4719
(973) 941-3769
Mailing address
180 LAFAYETTE AVE, APT. 12A, PASSAIC, NJ 07055-4719
(973) 941-3769
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
25MD00277500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018171
—
NJ
Enumeration date
03/12/2007
Last updated
06/01/2016
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