Provider Demographics
NPI:1174289797
Name:BLAIR, ERIC MARSHALL (RN)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:MARSHALL
Last Name:BLAIR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:MARSHALL
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:543 E 6TH ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6677
Mailing Address - Country:US
Mailing Address - Phone:917-648-7928
Mailing Address - Fax:
Practice Address - Street 1:543 E 6TH ST APT 2R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-6677
Practice Address - Country:US
Practice Address - Phone:917-648-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY824039163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice