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General NPI Number Information
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NPI Number | 1710636253
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Entity Type | Individual
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Provider Name | ELAINE ROSE BLACKMAN DO
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Gender | Female
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 4950 STATE HIGHWAY 30
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City | AMSTERDAM
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State | NY
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Zip | 12010-7520
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Country | US
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Telephone | 518-841-3770
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Fax | 518-841-3775
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Provider Business Mailing Address
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Address Line | 70 WILKES AVE
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City | AMSTERDAM
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State | NY
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Zip | 12010-1315
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Country | US
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Telephone | 603-991-3187
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 337680
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License Number State | NY
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