=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467313932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOUGLAS BLANCO RNFA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2025
-----------------------------------------------------
Last Update Date | 11/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 438 W 51ST ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-6503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-333-7300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 BELL SLIP APT 2D
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11222-7600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-397-3995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WR0006X
-----------------------------------------------------
Taxonomy Name | Registered Nurse First Assistant
-----------------------------------------------------
License Number | 26NR24234500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WR0006X
-----------------------------------------------------
Taxonomy Name | Registered Nurse First Assistant
-----------------------------------------------------
License Number | 762921
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------