1396431011 NPI number — MR. BJORN MONTEVANNE BLACKWOOD MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396431011 NPI number — MR. BJORN MONTEVANNE BLACKWOOD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACKWOOD
Provider First Name:
BJORN
Provider Middle Name:
MONTEVANNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396431011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/17/2023
NPI Reactivation Date:
10/30/2025

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56 NORBROOK DRIVE, KINGSTON 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
KINGSTON
Provider Business Mailing Address Postal Code:
00876
Provider Business Mailing Address Country Code:
JM
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 LENNOX AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-939-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com