Active NPI
Marc Blank, M.S., M.S., ED.M.
- Counselor
- Manalapan, NJ
National Provider Identifier
1063774909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 24 Baltusrol Dr
Manalapan, NJ 07726-9325 - Phone
- (732) 319-0191
- NPI assigned
- Jun 15, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 510128931 | NY | |
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
24 Baltusrol Dr
Manalapan, NJ 07726-9325
Mailing address
24 Baltusrol Dr
Manalapan, NJ 07726-9325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 510128931 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637193600000",
"number": "1063774909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 BALTUSROL DR",
"city": "MANALAPAN",
"state": "NJ",
"postal_code": "077269325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 BALTUSROL DR",
"city": "MANALAPAN",
"state": "NJ",
"postal_code": "077269325",
"telephone_number": "732-319-0191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLANK",
"first_name": "MARC",
"name_prefix": "Mr.",
"credential": "M.S., M.S., ED.M.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-15",
"last_updated": "2021-11-18",
"certification_date": "2021-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "510128931",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manalapan, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.