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Individual

MS. CAROL BLAKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A., R.N., M.P.H

Contact information

Practice address
111 E 210TH ST, NW7, MEDICINE, BRONX, NY 10467-2401
(718) 920-7441
Mailing address
111 E 210TH ST, NW7, MEDICINE, BRONX, NY 10467-2401
(718) 920-7441

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001435-1
NY

Other

Enumeration date
06/29/2009
Last updated
06/29/2009
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