Provider Demographics
NPI:1942526090
Name:PHILLIPS, BLAKE ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:ANDREW
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 GOLD ST
Mailing Address - Street 2:APARTMENT 504
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2034
Mailing Address - Country:US
Mailing Address - Phone:501-538-7333
Mailing Address - Fax:
Practice Address - Street 1:1 PARK AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5802
Practice Address - Country:US
Practice Address - Phone:501-538-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program