Provider Demographics
NPI:1710636253
Name:BLACKMAN, ELAINE ROSE (DO)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:ROSE
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:ROSE
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 WILKES AVE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1315
Mailing Address - Country:US
Mailing Address - Phone:603-991-3187
Mailing Address - Fax:
Practice Address - Street 1:427 GUY PARK AVE
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1064
Practice Address - Country:US
Practice Address - Phone:518-841-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337680208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics