Provider Demographics
NPI:1528540770
Name:BLANCA, ALEXIS E
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:E
Last Name:BLANCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 PARSONS BLVD APT 6L
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-1933
Mailing Address - Country:US
Mailing Address - Phone:347-403-2304
Mailing Address - Fax:
Practice Address - Street 1:950 LONGFELLOW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-4809
Practice Address - Country:US
Practice Address - Phone:718-893-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist