Healthcare Provider Details

I. General information

NPI: 1700893948
Provider Name (Legal Business Name): BETSY ALICE BLASKOPF GREENLEAF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETSY ALICE BLASKOPF DO

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CANDLEWOOD CMNS
HOWELL NJ
07731-2169
US

IV. Provider business mailing address

3 APPLEGATE RD
MILLSTONE TWP NJ
08510-1540
US

V. Phone/Fax

Practice location:
  • Phone: 866-758-2357
  • Fax: 732-284-3623
Mailing address:
  • Phone: 480-269-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MB070323300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: