Provider Demographics
NPI:1326021452
Name:BLANK, ALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:BLANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLA
Other - Middle Name:
Other - Last Name:DONSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 PARK PLACE 12TH FLOOT, SUITE 1200
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007
Mailing Address - Country:US
Mailing Address - Phone:212-226-7666
Mailing Address - Fax:718-226-1039
Practice Address - Street 1:15 WARREN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007
Practice Address - Country:US
Practice Address - Phone:212-226-7666
Practice Address - Fax:718-227-0132
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204065208000000X
NJ25MA07053800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01840500Medicaid
NY01840500Medicaid