Provider Demographics
NPI:1518308758
Name:BLYSKAL, STASIA (DO)
Entity Type:Individual
Prefix:DR
First Name:STASIA
Middle Name:
Last Name:BLYSKAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 COURT ST STE 1901
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4421
Mailing Address - Country:US
Mailing Address - Phone:917-597-6894
Mailing Address - Fax:929-335-7962
Practice Address - Street 1:32 COURT ST STE 1901
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4421
Practice Address - Country:US
Practice Address - Phone:917-597-6894
Practice Address - Fax:929-335-7962
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275445204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM