MEDICARE: DR. HARVEY BLUTH MD

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	207N00000X	Dermatology Physician	126744	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	:	1801965108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARVEY BLUTH MD

Provider Business Mailing Address
First Line	:	PO BOX 340350
Second Line	:	5700 AVE N
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-252-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 AVE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-252-7070
Fax Number	:

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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