Blake, Traci

Blake, Traci is an individual health care provider with primary practice located at 401 S Van Brunt St Ste 3 , Englewood NJ 07631-4600. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Blake, Traci can be contacted via phone (201) 569-2770.

Contact Information

Primary practice address
401 S Van Brunt St Ste 3 Englewood NJ 07631-4600
Phone: (201) 569-2770
Fax: (201) 569-1774
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 021388 New York
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 25MP00449500 New Jersey

Profile Details

NPI number 1922519271
LBN Legal business name Blake, Traci
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2017
Last updated Jul 18th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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