Provider Demographics
NPI:1427151307
Name:CHRISTOPH, BLAKE M (CPO)
Entity type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:M
Last Name:CHRISTOPH
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OLD YORK RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1611
Mailing Address - Country:US
Mailing Address - Phone:215-886-3620
Mailing Address - Fax:
Practice Address - Street 1:801 OLD YORK RD
Practice Address - Street 2:SUITE 315
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1611
Practice Address - Country:US
Practice Address - Phone:215-886-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA282753OtherPENNSYLVANIA BLUE SHIELD
PA3910OtherAETNA
PA0002587000OtherPERSONAL CHOICE
PA0002587000OtherKEYSTONE HEALTH PLAN EAST
PA0561550Medicaid
NJ3486303Medicaid
PA0561550Medicaid