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General NPI Number Information
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NPI Number | 1508123639
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Entity Type | Organization
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Legal Business Name | PHILIP B. BLANK JR. D.O. P.C.
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 325 MANVILLE RD.
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City | PLEASANTVILLE
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State | NY
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Zip | 10570
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Country | US
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Telephone | 914-747-5600
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Fax | 914-747-7085
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Provider Business Mailing Address
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Address Line | 325 MANVILLE RD
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-2122
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Country | US
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Telephone | 914-747-5600
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Fax | 914-747-7085
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. PHILIP B BLANK JR.
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Credential | D.O.
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Telephone | 914-747-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 189508
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License Number State | NY
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