Individual
TRACI BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
401 S VAN BRUNT ST STE 3, ENGLEWOOD, NJ 07631-4600
(201) 569-2770
(201) 569-1774
Mailing address
401 S VAN BRUNT ST STE 3, ENGLEWOOD, NJ 07631-4600
(201) 569-2770
(201) 569-1774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
021388
NY
363A00000X
Physician Assistant
Primary
25MP00449500
NJ
Other
Enumeration date
10/13/2017
Last updated
07/18/2022
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