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General NPI Number Information
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NPI Number | 1326078320
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Entity Type | Individual
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Provider Name | KENNETH B BLATT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 2130 MILLBURN AVE SUITE A8
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3725
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Country | US
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Telephone | 732-383-4166
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Fax | 732-383-4171
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Provider Business Mailing Address
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Address Line | 4000 ROUTE 66 SUITE 131
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City | TINTON FALLS
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State | NJ
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Zip | 07753-7300
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Country | US
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Telephone | 732-383-4166
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Fax | 732-383-4171
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 25MA07602800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA07602800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 25MA07602800
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License Number State | NJ
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