Healthcare Provider Details

I. General information

NPI: 1255683652
Provider Name (Legal Business Name): SIMON BLANC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 BAY RD APT 1514
MIAMI BEACH FL
33139-3213
US

IV. Provider business mailing address

1500 BAY RD APT 1514
MIAMI BEACH FL
33139-3213
US

V. Phone/Fax

Practice location:
  • Phone: 347-553-1443
  • Fax:
Mailing address:
  • Phone: 347-553-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number280991
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME129886
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: