Healthcare Provider Details

I. General information

NPI: 1831392562
Provider Name (Legal Business Name): LENORE J BLANK MSN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 201
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

1233 RICHMOND RD
MAHWAH NJ
07430-3238
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-2937
  • Fax:
Mailing address:
  • Phone: 201-327-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00114000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: