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General NPI Number Information
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NPI Number | 1982461380
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Entity Type | Organization
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Legal Business Name | BLACKAGE, LLC
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 320 CENTRAL PARK W UNIT 18B
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City | NEW YORK
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State | NY
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Zip | 10025-7659
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Country | US
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Telephone | 916-779-9212
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Fax |
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Provider Business Mailing Address
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Address Line | 2414 CAMPBELL AVE
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City | SCHENECTADY
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State | NY
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Zip | 12306-3204
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Country | US
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Telephone | 916-779-9212
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COURTENEY GENIECE NELSON
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Credential |
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Telephone | 916-779-9212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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