Healthcare Provider Details

I. General information

NPI: 1619825551
Provider Name (Legal Business Name): MAGALI JUSTINE BLANCO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

607 129TH ST FL 1
COLLEGE POINT NY
11356-1311
US

V. Phone/Fax

Practice location:
  • Phone: 347-828-5076
  • Fax:
Mailing address:
  • Phone: 347-828-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: