Individual
PETER JOEL BLACKBURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3 JEFFERSON AVE, VALLEY STREAM, NY 11580-2925
(718) 775-1200
Mailing address
3 JEFFERSON AVE, VALLEY STREAM, NY 11580-2925
(718) 775-1200
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
535252
NY
Other
Enumeration date
09/26/2018
Last updated
10/10/2018
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