Individual
CAMILLE BLACKWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
55 BONITA VISTA RD, MOUNT VERNON, NY 10552-1301
(718) 644-2885
Mailing address
55 BONITA VISTA RD, MOUNT VERNON, NY 10552-1301
(718) 644-2885
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W246311245
AETNA
NY
Enumeration date
03/29/2019
Last updated
03/29/2019
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