MEDICARE: ROBERT GARY BLAKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	213092-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023036548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT GARY BLAKE MD

Provider Business Mailing Address
First Line	:	591 HANCOCK ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-6584
Country	:	US
Telephone Number	:	917-279-3308
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 ROEBLING ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-6204
Country	:	US
Telephone Number	:	718-218-6414
Fax Number	:	718-240-0411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/08/2025

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