Healthcare Provider Details

I. General information

NPI: 1467313932
Provider Name (Legal Business Name): DOUGLAS BLANCO RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 W 51ST ST
NEW YORK NY
10019-6503
US

IV. Provider business mailing address

1 BELL SLIP APT 2D
BROOKLYN NY
11222-7600
US

V. Phone/Fax

Practice location:
  • Phone: 212-333-7300
  • Fax:
Mailing address:
  • Phone: 917-397-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NR24234500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number762921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: