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General NPI Number Information
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NPI Number | 1154530327
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Entity Type | Individual
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Provider Name | AGNES BLAU MD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 85 WEBSTER AVENUE
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City | PORT WASHINGTON
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State | NY
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Zip | 11050
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Country | US
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Telephone | 516-767-0169
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 567
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City | PORT WASHINGTON
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State | NY
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Zip | 11050
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Country | US
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Telephone | 516-829-3637
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 162329
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License Number State | NY
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