Julie Ann Blake, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

222482-1 Issued in NY

Practice address

105 Stevens Ave
Suite 406
Mount Vernon, NY 10550

Phone

(914) 371-7606

Fax

(914) 371-7622

NPI assigned

Jul 26, 2006

Last updated

Aug 25, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1831113521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 STEVENS AVE",
            "address_2": "SUITE 406",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "10550",
            "telephone_number": "914-371-7606",
            "fax_number": "914-371-7622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 STEVENS AVE",
            "address_2": "SUITE 406",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "10550",
            "telephone_number": "914-371-7606",
            "fax_number": "914-371-7622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JULIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "222482-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02290559",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seth A Biser, M.D.
• Cheray S. Black, RN
• Cheryl Elizabeth Blackmon-Thorne, C.O.T.A.
• Camille Blackwood
• Angela Velmarie Blake
• Lori B Blake
• Sardia Blake, PCT
• Nora A Blonda-Gil, DDS
• Daniel Yaw Boadu, NPP
• Yiadom Kwadwo Boakye-Danquah, PHARMD

• Pediatrics Physician in Mount Vernon, NY
• Providers in Mount Vernon, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.