Healthcare Provider Details

I. General information

NPI: 1720019052
Provider Name (Legal Business Name): KENNETH H GOLDBLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PLAINSBORO ROAD SUITE 300
PLAINSBORO NJ
08536
US

IV. Provider business mailing address

3626 US HIGHWAY 1
PRINCETON NJ
08540-5922
US

V. Phone/Fax

Practice location:
  • Phone: 609-853-7272
  • Fax: 609-853-7271
Mailing address:
  • Phone: 609-243-0445
  • Fax: 609-452-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA03084500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: