Provider Demographics
NPI:1508123639
Name:PHILIP B. BLANK JR. D.O. P.C.
Entity Type:Organization
Organization Name:PHILIP B. BLANK JR. D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLANK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:914-747-5600
Mailing Address - Street 1:325 MANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2122
Mailing Address - Country:US
Mailing Address - Phone:914-747-5600
Mailing Address - Fax:914-747-7085
Practice Address - Street 1:325 MANVILLE RD.
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570
Practice Address - Country:US
Practice Address - Phone:914-747-5600
Practice Address - Fax:914-747-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189508207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY090511Medicare UPIN