Healthcare Provider Details

I. General information

NPI: 1679311633
Provider Name (Legal Business Name): STEVEN BLAKE CPHT, RPHT, M.ED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 10/06/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

560 1ST AVE
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5047
  • Fax:
Mailing address:
  • Phone: 646-929-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number006157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: