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General NPI Number Information
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NPI Number | 1154591352
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Entity Type | Organization
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Legal Business Name | GAIL M BLUMENTHAL OD PA
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 17 GRAND AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3508
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Country | US
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Telephone | 201-894-1400
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Fax | 201-894-0220
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Provider Business Mailing Address
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Address Line | 17 GRAND AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3508
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Country | US
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Telephone | 201-894-1400
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Fax | 201-894-0220
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GAIL M BLUMENTHAL
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Credential | OD
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Telephone | 201-894-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00395300
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License Number State | NJ
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