Individual
TIMOTHY BLANDFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1149 SULLIVAN ST, ELMIRA, NY 14901
(607) 733-7661
(607) 733-7675
Mailing address
1149 SULLIVAN ST, ELMIRA, NY 14901-1670
(607) 733-7661
(607) 733-7675
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0266L01
NY
Other
Enumeration date
03/31/2017
Last updated
03/31/2017
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