Provider Demographics
NPI:1871765446
Name:BLANKENBUEHLER, ELEONORA
Entity type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:BLANKENBUEHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELEONORA
Other - Middle Name:
Other - Last Name:BLANKENBUEHLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN ASSISTATN
Mailing Address - Street 1:150 W 95TH ST APT 8C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6667
Mailing Address - Country:US
Mailing Address - Phone:212-873-3232
Mailing Address - Fax:
Practice Address - Street 1:150 W 95TH ST APT 8C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6667
Practice Address - Country:US
Practice Address - Phone:212-873-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant