Robert Demarest Blake Jr.

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

251326-1 Issued in NY

Practice address

11242 Mills Mills Rd
Fillmore, NY 14735-8622

Phone

(214) 223-1567

NPI assigned

Apr 6, 2015

Last updated

Apr 6, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428278400000",
    "number": "1285029389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11242 MILLS MILLS RD",
            "city": "FILLMORE",
            "state": "NY",
            "postal_code": "147358622",
            "telephone_number": "214-223-1567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11242 MILLS MILLS RD",
            "city": "FILLMORE",
            "state": "NY",
            "postal_code": "147358622",
            "telephone_number": "214-223-1567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "ROBERT",
        "middle_name": "DEMAREST",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-06",
        "last_updated": "2015-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NY",
            "license": "251326-1",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "251326-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Marie Armison, LPN
• Audra Janis Beardsley, M.S., CCC-SLP
• Jaime D Beardsley, MA, CCC-SLP
• Naomi Jo Bennion, LPN
• Karen Lynn Dziuba, LPN
• Fillmore & Fisher Pharmacy, Inc (Fillmore Pharmacy)
• Fillmore & Fisher Pharmacy, Inc (Fillmore Pharmacy LTC)
• Fillmore Central School
• Fillmore Physical Therapy LLC

• Licensed Practical Nurse in Fillmore, NY
• Providers in Fillmore, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.