Blanco, Edison Roque
Blanco, Edison Roque is an sole proprietor health care provider with primary practice located at 16 Brentwood Rd , Bay Shore NY 11706-8011. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Blanco, Edison Roque can be contacted via phone (631) 969-7875.Contact Information
Primary practice address
16 Brentwood Rd
Bay Shore NY 11706-8011
Phone: (631) 969-7875
Fax: (631) 969-7883
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 189607 | New York |
Profile Details
| NPI number | 1184633687 |
|---|---|
| LBN Legal business name | Blanco, Edison Roque |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 5th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184633687 | NPPES |
| New York | MEDICAID | 01634335 |
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