Traci Blake, PA
Physician Assistant in Englewood, New Jersey
1922519271- Practice location
- 401 S Van Brunt St Ste 3, Englewood, NJ 07631-4600
- Phone
- 201-569-2770
- Fax
- 201-569-1774
- Last updated
- July 18, 2022
Traci Blake is a Physician Assistant based in Englewood, NJ. Traci Blake practices in Englewood, NJ and has the professional credentials of PA. The NPI Number for Traci Blake is 1922519271 and holds a License No. 021388 (NY). The current practice location address for Traci Blake is 401 S Van Brunt St Ste 3, Englewood, NJ 07631-4600 and can be reached out via phone at 201-569-2770 and via fax at 201-569-1774.
Provider Profile Details
- NPI Number
- 1922519271
- Provider Name
- Traci Blake
- Credential
- PA
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 401 S Van Brunt St Ste 3, Englewood, NJ 07631-4600
- Phone Number
- 201-569-2770
- Fax Number
- 201-569-1774
- Primary Taxonomy
- Physician Assistant · 363A00000X
- Sole Proprietor
- No
- Provider Enumeration Date
- October 13, 2017
- Last Update Date
- July 18, 2022
- Certification Date
- July 18, 2022
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 401 S Van Brunt St Ste 3
Englewood, NJ 07631-4600 - City
- Englewood
- State
- New Jersey
- Zip
- 07631-4600
- Phone Number
- 201-569-2770
- Fax Number
- 201-569-1774
Provider Business Mailing Address Details
- Address
- 401 S Van Brunt St Ste 3
Englewood, NJ 07631-4600 - City
- Englewood
- State
- NJ
- Zip
- 07631-4600
- Phone Number
- 201-569-2770
- Fax Number
- 201-569-1774
License Information
- License Number (1)
- 021388
- License State (1)
- NY
- Taxonomy (1)
- Physician Assistant · 363A00000X
- License Number (2)
- 25mp00449500
- License State (2)
- NJ
- Taxonomy (2)
- Physician Assistant · 363A00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Traci Blake, PA?
The NPI number of Traci Blake, PA is 1922519271. It was assigned on October 13, 2017 and is currently active in the NPPES registry.
What is the specialty of Traci Blake, PA?
Traci Blake, PA is registered under the primary taxonomy Physician Assistant (code 363A00000X), licensed in NY under license number 021388.
Where does Traci Blake, PA practice?
The practice location is 401 S Van Brunt St Ste 3, Englewood, NJ 07631-4600. The office can be reached at 201-569-2770 (phone) or 201-569-1774 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1922519271 directly on the NPPES registry website.