Healthcare Provider Details

I. General information

NPI: 1568099026
Provider Name (Legal Business Name): MICHAEL KORNBLIT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 32ND ST
NEW YORK NY
10016-6058
US

IV. Provider business mailing address

1945 EASTCHESTER RD APT 22G
BRONX NY
10461-2111
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5940
  • Fax: 212-263-5808
Mailing address:
  • Phone: 516-428-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number322710
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: