Healthcare Provider Details

I. General information

NPI: 1861493405
Provider Name (Legal Business Name): WESLEY S BLANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE SUITE 10C
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

PO BOX 95000-2243
PHILADELPHIA PA
19195-2243
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-3452
  • Fax: 212-523-8066
Mailing address:
  • Phone: 516-338-5300
  • Fax: 516-338-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1474182
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: