Healthcare Provider Details

I. General information

NPI: 1235194416
Provider Name (Legal Business Name): DAVID R BLUMENTHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL MEDICAL SERVICE (111 BK)
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

800 POLY PL MEDICAL SERVICE (BK-111)
BROOKLYN NY
11209-7104
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-3766
  • Fax: 718-630-3761
Mailing address:
  • Phone: 718-639-3766
  • Fax: 718-630-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number134484
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: