Provider Demographics
NPI:1902232358
Name:CHERUBINI, BLANKI (MD)
Entity Type:Individual
Prefix:
First Name:BLANKI
Middle Name:
Last Name:CHERUBINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RESERVOIR AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6043
Mailing Address - Country:US
Mailing Address - Phone:401-401-0159
Mailing Address - Fax:
Practice Address - Street 1:1150 RESERVOIR AVE STE 303
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6043
Practice Address - Country:US
Practice Address - Phone:401-401-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276099208100000X
CAA130761208100000X
RIMD14843208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation