Provider Demographics
NPI:1194799239
Name:BLAKESLEE, CHRISTOPHER H (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:H
Last Name:BLAKESLEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W VETERANS HWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3435
Mailing Address - Country:US
Mailing Address - Phone:732-833-6888
Mailing Address - Fax:732-833-6280
Practice Address - Street 1:100 W VETERANS HWY
Practice Address - Street 2:SUITE 11
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3435
Practice Address - Country:US
Practice Address - Phone:732-833-6888
Practice Address - Fax:732-833-6280
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00263900213E00000X, 213ES0000X
NJ25MD002639213ER0200X
NJ25MD00262900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9052801Medicaid
NJ9052801Medicaid
NJ065985Medicare PIN