Provider Demographics
NPI:1982705877
Name:BLAKE, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:BLAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:170 COLD SOIL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-4202
Mailing Address - Country:US
Mailing Address - Phone:609-896-1122
Mailing Address - Fax:609-896-2688
Practice Address - Street 1:170 COLD SOIL RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-4202
Practice Address - Country:US
Practice Address - Phone:609-896-1122
Practice Address - Fax:609-896-2688
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA046759002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF13776Medicare UPIN