Healthcare Provider Details

I. General information

NPI: 1932377413
Provider Name (Legal Business Name): THE MEDEX MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 HEMPSTEAD AVE
MALVERNE NY
11565-2034
US

IV. Provider business mailing address

245 HEMPSTEAD AVE
MALVERNE NY
11565-2034
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-5885
  • Fax: 516-599-5442
Mailing address:
  • Phone: 516-599-5885
  • Fax: 516-599-5442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number126420
License Number StateNY

VIII. Authorized Official

Name: DR. GEORGE M BLATTI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-599-5885