MEDICARE: DR. BRIAN PAUL BLUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	00217662	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053328914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN PAUL BLUM M.D.

Provider Business Mailing Address
First Line	:	247 E 28TH ST
Second Line	:	APARTMENT 17A
City	:	NEW YORK
State	:	NY
Zip	:	10016-8508
Country	:	US
Telephone Number	:	210-834-7678
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 E 28TH ST
Second Line	:	APARTMENT 17A
City	:	NEW YORK
State	:	NY
Zip	:	10016-8508
Country	:	US
Telephone Number	:	210-834-7678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/09/2007

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