Provider Demographics
NPI:1194087668
Name:BLANCO, EILEEN M
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:BLANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 E 99TH ST
Mailing Address - Street 2:APT 14
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6714
Mailing Address - Country:US
Mailing Address - Phone:732-882-2669
Mailing Address - Fax:
Practice Address - Street 1:163 E 99TH ST
Practice Address - Street 2:APT 14
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6714
Practice Address - Country:US
Practice Address - Phone:732-882-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist