Provider Demographics
NPI:1356839286
Name:BLASZAK, JACQUELINE ELYSE (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELYSE
Last Name:BLASZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8117 PRESTON RD APOGEE PHYSICIANS
Mailing Address - Street 2:SUITE 800
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225
Mailing Address - Country:US
Mailing Address - Phone:214-666-9611
Mailing Address - Fax:208-697-5214
Practice Address - Street 1:462 GRIDER ST. ERIE COUNTY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-961-6995
Practice Address - Fax:716-898-5193
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY308904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine