Healthcare Provider Details

I. General information

NPI: 1346530151
Provider Name (Legal Business Name): EMILY BLANTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAIDEN LN FL 3
NEW YORK NY
10038-4831
US

IV. Provider business mailing address

90 MAIDEN LN FL 3
NEW YORK NY
10038-4831
US

V. Phone/Fax

Practice location:
  • Phone: 646-290-9560
  • Fax:
Mailing address:
  • Phone: 646-290-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number28849401
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME122598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: