Individual
BLAKE DUCOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
390 ROUTE NJ 10, SUITE 202, RANDOLPH, NJ 07869
(973) 895-9925
(973) 895-9927
Mailing address
576 BROADHOLLOW RD, MELVILLE, NY 11747-5002
(631) 359-5859
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01956200
NJ
Other
Enumeration date
09/15/2020
Last updated
09/15/2020
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