1457318198 NPI number — ROBERT EUGENE BLACKBURN M.D.

Table of content: ROBERT EUGENE BLACKBURN M.D. (NPI 1457318198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457318198 NPI number — ROBERT EUGENE BLACKBURN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACKBURN
Provider First Name:
ROBERT
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1457318198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
279 EAST AVE
Provider Second Line Business Mailing Address:
HILTON HEALTH CARE, P.C.
Provider Business Mailing Address City Name:
HILTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14468-1333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-392-9100
Provider Business Mailing Address Fax Number:
585-392-4020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
279 EAST AVE
Provider Second Line Business Practice Location Address:
HILTON HEALTH CARE, P.C.
Provider Business Practice Location Address City Name:
HILTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14468-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-392-9100
Provider Business Practice Location Address Fax Number:
585-392-4020
Provider Enumeration Date:
04/27/2006

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: 207Q00000X , with the licence number:  169882 , 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: MD130D . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5520487 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01039918 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000912964001 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CFP1698828 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6948 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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