Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Daryle Marc Blackstock, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1295820298

Mr. Daryle Marc Blackstock, PHYSICIANASSISTANT is a Physician Assistant in New York, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2006

Practice location Address checks out

622 W 168th St Ph 14 Rm 104
New York, NY 10032-3720
Phone: (212) 305-7771
Fax: (212) 342-5307
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 006279-1 (NY)

Record details

NPI number1295820298
Entity typeIndividual (Type 1)
GenderMale
Credentials PHYSICIANASSISTANT
Sole proprietorYes
NPI enumeratedOctober 4, 2006
Last updated in NPPESJuly 15, 2015

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