MEDICARE: ANTHONY BLASKOVIC

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1063355923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY BLASKOVIC

Provider Business Mailing Address
First Line	:	15712 22ND AVE
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-3911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 ELMWOOD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2913
Country	:	US
Telephone Number	:	585-275-5051
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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