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1336828680 NPI number — MARY CHRISSEN LOY BLACKMAN OD

NPI Number: 1336828680
Health Care Provider/Practitioner: MARY CHRISSEN LOY BLACKMAN OD

Information about “1336828680” NPI (MARY CHRISSEN LOY BLACKMAN OD) exists in 1336828680 in HTML format HTML  |  1336828680 in plain Text format TXT  |  1336828680 in PDF (Portable Document Format) PDF  |  1336828680 in an XML format XML  formats.

NPI Number : 1336828680 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336828680",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLACKMAN",
    "FirstName": "MARY CHRISSEN LOY",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "OD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "15074 GOETHALS AVE APT 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JAMAICA",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11432-1144",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "917-691-8678",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "150 BROADWAY RM 1401",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW YORK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10038-4378",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "212-233-2344",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/13/2023",
    "LastUpdateDate": "07/13/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "009801",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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