Provider Demographics
NPI:1700893948
Name:GREENLEAF, BETSY ALICE BLASKOPF (DO)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:ALICE BLASKOPF
Last Name:GREENLEAF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:BETSY
Other - Middle Name:ALICE
Other - Last Name:BLASKOPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3 APPLEGATE RD
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-1540
Mailing Address - Country:US
Mailing Address - Phone:480-269-3621
Mailing Address - Fax:
Practice Address - Street 1:201 CANDLEWOOD CMNS
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2169
Practice Address - Country:US
Practice Address - Phone:866-758-2357
Practice Address - Fax:732-284-3623
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB070323300207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI23446Medicare UPIN
NJ086742Medicare ID - Type Unspecified