Provider Demographics
NPI:1275550246
Name:BLAKEMAN, INNA (DPM)
Entity Type:Individual
Prefix:DR
First Name:INNA
Middle Name:
Last Name:BLAKEMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BROADWAY
Mailing Address - Street 2:SUITE 2018
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-3001
Mailing Address - Country:US
Mailing Address - Phone:212-385-8083
Mailing Address - Fax:212-693-4014
Practice Address - Street 1:225 BROADWAY
Practice Address - Street 2:SUITE 2018
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3001
Practice Address - Country:US
Practice Address - Phone:212-385-8083
Practice Address - Fax:212-693-4014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004872213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP55671Medicare ID - Type Unspecified
NYU29484Medicare UPIN