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General NPI Number Information
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NPI Number | 1295200145
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Entity Type | Individual
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Provider Name | SARAH JANE TANILON BLANCO
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Gender | Female
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 55 NORTHERN BLVD STE 103
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City | GREAT NECK
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State | NY
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Zip | 11021-4058
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Country | US
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Telephone | 516-466-9300
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Fax | 516-466-9353
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Provider Business Mailing Address
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Address Line | 8523 52ND AVE
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City | ELMHURST
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State | NY
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Zip | 11373-4322
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Country | US
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Telephone | 707-564-0430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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