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General NPI Number Information
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NPI Number | 1053596858
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Entity Type | Individual
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Provider Name | MICHAEL HOWARD BLUMENTHAL RPH
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Gender | Male
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 2456 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5804
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Country | US
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Telephone | 718-697-0422
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Fax |
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Provider Business Mailing Address
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Address Line | 85 WASHINGTON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5044
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Country | US
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Telephone | 718-698-9068
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI01574600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 030092
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License Number State | NY
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