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NPI Code Detail

MEDICARE: DR. MARK GUDESBLATT M.D.

MEDICARE: DR. MARK GUDESBLATT 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
12084N0400XNeurology Physician147227NY

Other Identifiers

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

General Provider Information

NPI Number : 1528030269
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK GUDESBLATT M.D.
Provider Business Mailing Address
First Line : 712 MAIN ST
Second Line :
City : ISLIP
State : NY
Zip : 11751-3620
Country : US
Telephone Number : 631-666-3939
Fax Number : 631-666-3994
Provider Business Practice Location Address
First Line : 712 MAIN ST
Second Line :
City : ISLIP
State : NY
Zip : 11751-3620
Country : US
Telephone Number : 631-666-3939
Fax Number : 631-666-3994
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 09/13/2016

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