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General NPI Number Information
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NPI Number | 1447384870
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Entity Type | Individual
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Provider Name | TERESA F. BLANCO M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10401 ROOSEVELT AVE
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City | CORONA
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State | NY
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Zip | 11368-2327
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Country | US
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Telephone | 718-672-1800
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Fax | 718-424-6876
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Provider Business Mailing Address
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Address Line | 4511 159TH ST
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City | FLUSHING
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State | NY
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Zip | 11358-3147
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Country | US
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Telephone | 718-939-3022
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Fax | 718-460-9505
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 117416
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License Number State | NY
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