Healthcare Provider Details

I. General information

NPI: 1255350583
Provider Name (Legal Business Name): ANDREW L BLANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3526 FRANCIS LEWIS BLVD
FLUSHING NY
11358-1954
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 718-631-8899
  • Fax: 718-631-4401
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number169492
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: