1407841588 NPI number — EDWARD BLUM PT

Table of content: EDWARD BLUM PT (NPI 1407841588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407841588 NPI number — EDWARD BLUM PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLUM
Provider First Name:
EDWARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1407841588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3611 E TREMONT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10465-2053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-822-2281
Provider Business Mailing Address Fax Number:
718-587-8485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3611 E TREMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10465-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-904-0946
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2005

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: 174400000X , with the licence number:  0067451 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0469643000 . This is a "AMERIHEALTH #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 128588 . This is a "MPN #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5526049 . This is a "AETNA PPO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 109258200 . This is a "DEPARTMENT OF LABOR #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q6643 . This is a "EMPIRE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 006754-A81 . This is a "HEALTHFIRST #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0125088 . This is a "AETNA HMO #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 133586197 . This is a "TAX IDENTIFICATION #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000001747 . This is a "AFFINITY #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C1509 . This is a "HEALTHNET #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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