1497864458 NPI number — JEFFREY D BLONSTEIN MD

Table of content: JEFFREY D BLONSTEIN MD (NPI 1497864458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497864458 NPI number — JEFFREY D BLONSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLONSTEIN
Provider First Name:
JEFFREY
Provider Middle Name:
D
Provider Name Prefix Text:
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:
1497864458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 MILLBURN AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MILLBURN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-376-0900
Provider Business Mailing Address Fax Number:
973-376-0010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 MILLBURN AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MILLBURN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-376-0900
Provider Business Practice Location Address Fax Number:
973-376-0010
Provider Enumeration Date:
08/30/2006

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: 2085R0202X , with the licence number:  25MA04044900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00842996 . This is a "RR MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0084954000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0522406 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01000034100 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com