John Robert Blake, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25MA04675900 Issued in NJ

Practice address

170 Cold Soil Rd
Princeton, NJ 08540-4202

Phone

(609) 896-1122

Fax

(609) 896-2688

NPI assigned

Sep 26, 2006

Last updated

Aug 28, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598572800000",
    "number": "1982705877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 COLD SOIL RD",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085404202",
            "telephone_number": "609-896-1122",
            "fax_number": "609-896-2688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 COLD SOIL RD",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085404202",
            "telephone_number": "609-896-1122",
            "fax_number": "609-896-2688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA04675900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bio-Medical Applications of New Jersey, Inc. (Bma Princeton)
• Birdsong Healing Psychiatry
• Caroline Elizabeth Black, LCSW
• Janet L Black
• Hathi Blackman, L.C.S.W.
• Kathleen M Bland, LCSW
• Thomas R Blom, M.D.
• Blossom Wellness, LLC
• Amanda Blum, PT
• Carol Blum, PSY.D.

• Psychiatry Physician in Princeton, NJ
• Providers in Princeton, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.