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General NPI Number Information
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NPI Number | 1952298754
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Entity Type | Individual
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Provider Name | BLAKE JOHN BASKIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 98 SHAKER RD
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-2731
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Country | US
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Telephone | 413-798-0301
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Fax |
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Provider Business Mailing Address
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Address Line | 121 SHALLOW BROOK WAY
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City | SUFFIELD
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State | CT
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Zip | 06078-1240
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Country | US
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Telephone | 860-729-2305
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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