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General NPI Number Information
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NPI Number | 1316204167
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Entity Type | Individual
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Provider Name | JEAN JHERRY BLANC LPN
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Gender | Male
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 500 W 57TH ST
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City | NEW YORK
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State | NY
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Zip | 10019-2902
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Country | US
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Telephone | 862-224-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 16 MARSHALL ST APT 10-U
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City | IRVINGTON
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State | NJ
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Zip | 07111
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Country | US
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Telephone | 862-224-9980
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 308701-1
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License Number State | NY
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