Healthcare Provider Details

I. General information

NPI: 1942293899
Provider Name (Legal Business Name): BLANDINE B LAFERRERE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 113TH ST
NEW YORK NY
10025-9700
US

IV. Provider business mailing address

630 W 168TH ST BOX 4
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6421
  • Fax:
Mailing address:
  • Phone: 212-342-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number196866
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: