Individual
DR. SHANE ANTHONY BLACKMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 E 17TH ST, ROOM 1402, NEW YORK, NY 10003-3804
(212) 598-6509
(212) 598-7654
Mailing address
2 COOPER SQ, 9C, NEW YORK, NY 10003-7153
(347) 463-3405
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
P89608
NY
Other
Enumeration date
08/21/2013
Last updated
08/21/2013
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