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JODY BLANCO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
161 FORT WASHINGTON AVE, NEW YORK, NY 10032-3729
(212) 305-1107
Mailing address
622 W 168TH ST, NEW YORK, NY 10032-3720
(212) 305-4098

Taxonomy

Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
152716-1
NY
207VG0400X
Gynecology Physician
152716-1
NY

Other

Enumeration date
07/18/2006
Last updated
10/15/2013
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