Provider Demographics
NPI:1982330254
Name:BLANKA, GRACE (PA)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:BLANKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 OCEAN PKWY # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4831
Mailing Address - Country:US
Mailing Address - Phone:347-596-7602
Mailing Address - Fax:
Practice Address - Street 1:2218 OCEAN PKWY # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4831
Practice Address - Country:US
Practice Address - Phone:347-596-7602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant