Provider Demographics
NPI:1508202128
Name:BLANDO, JESSICA
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:BLANDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 PRESTON RD
Mailing Address - Street 2:APT D3
Mailing Address - City:MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08848-1248
Mailing Address - Country:US
Mailing Address - Phone:908-405-1465
Mailing Address - Fax:
Practice Address - Street 1:174 PRESTON RD
Practice Address - Street 2:APT D 3
Practice Address - City:MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:08848
Practice Address - Country:US
Practice Address - Phone:908-405-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00253000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant