Healthcare Provider Details

I. General information

NPI: 1750446241
Provider Name (Legal Business Name): HOWARD MICHAEL BLANK D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 CENTRAL PARK AVE
SCARSDALE NY
10583-1060
US

IV. Provider business mailing address

455 CENTRAL PARK AVE
SCARSDALE NY
10583-1060
US

V. Phone/Fax

Practice location:
  • Phone: 914-358-4018
  • Fax: 914-358-4020
Mailing address:
  • Phone: 914-358-4018
  • Fax: 914-358-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003068
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberN003068
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN003068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: