Individual provider · NPI-1

Trystan Blake, DO

Family Medicine · Middletown, NY

NPI number1275114753
StatusActive
Last updated in NPPESNov 26, 2024

Details

NPI
1275114753
Entity type
Individual (NPI-1)
Name
Trystan Blake
Credential
DO
Sex
Male
Sole proprietor
No
Enumeration date
Apr 16, 2021
Certification date
Nov 26, 2024
Last updated
Nov 26, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine13772735-1204UTYes

Practice location

707 E Main St
Middletown, NY 10940-2650

Phone 845-333-7373

Mailing address

707 E Main St
Middletown, NY 10940-2650

Other practice locations

82 S 1100 E Ste 403
Salt Lake City, UT 84102-1892

Phone 801-505-5299 · Fax 801-350-4753

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