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1710636253 NPI number — ELAINE ROSE BLACKMAN DO

NPI Number: 1710636253
Health Care Provider/Practitioner: ELAINE ROSE BLACKMAN DO

Information about “1710636253” NPI (ELAINE ROSE BLACKMAN DO) exists in 1710636253 in HTML format HTML  |  1710636253 in plain Text format TXT  |  1710636253 in PDF (Portable Document Format) PDF  |  1710636253 in an XML format XML  formats.

NPI Number : 1710636253 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710636253",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLACKMAN",
    "FirstName": "ELAINE",
    "MiddleName": "ROSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ARMSTRONG",
    "OtherFirstName": "ELAINE",
    "OtherMiddleName": "ROSE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "70 WILKES AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AMSTERDAM",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12010-1315",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "603-991-3187",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4950 STATE HIGHWAY 30",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AMSTERDAM",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12010-7520",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "518-841-3770",
    "PracticeLocationAddressFaxNumber": "518-841-3775",
    "EnumerationDate": "03/22/2022",
    "LastUpdateDate": "01/28/2026",
    "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": "208000000X",
        "TaxonomyName": "Pediatrics Physician",
        "LicenseNumber": "337680",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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