Provider Demographics
NPI:1861493405
Name:BLANK, WESLEY S (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:S
Last Name:BLANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-2243
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2243
Mailing Address - Country:US
Mailing Address - Phone:516-338-5300
Mailing Address - Fax:516-338-1075
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:SUITE 10C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-3452
Practice Address - Fax:212-523-8066
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2013-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1474182207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01749279Medicaid
NYB74425Medicare UPIN
NY01749279Medicaid