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General NPI Number Information
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NPI Number | 1962036095
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Entity Type | Individual
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Provider Name | BLAKE STOVEKEN
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Gender | Male
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 101 ROBERTS LN
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City | MILFORD
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State | PA
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Zip | 18337-7836
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Country | US
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Telephone | 570-409-9233
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Fax |
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Provider Business Mailing Address
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Address Line | 100 BY THE BROOK LN
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City | DINGMANS FERRY
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State | PA
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Zip | 18328-9550
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Country | US
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Telephone |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | KO000639
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License Number State | PA
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