Provider Demographics
NPI:1073692414
Name:BLAKE, JAMES ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALAN
Last Name:BLAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E 58TH ST
Mailing Address - Street 2:STE 301&304
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1236
Mailing Address - Country:US
Mailing Address - Phone:212-755-8700
Mailing Address - Fax:212-755-5342
Practice Address - Street 1:133 E 58TH ST
Practice Address - Street 2:SUITE 301/304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1236
Practice Address - Country:US
Practice Address - Phone:212-755-8700
Practice Address - Fax:212-755-5342
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150380207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
22D941Medicare ID - Type UnspecifiedMEDICARE NUMBER
A61325Medicare UPIN