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General NPI Number Information
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NPI Number | 1336136787
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Entity Type | Individual
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Provider Name | PAUL DAVID GREENBLATT M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 1855 UNION BLVD
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City | BAY SHORE
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State | NY
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Zip | 11706-7949
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Country | US
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Telephone | 631-665-3666
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5390
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City | BAY SHORE
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State | NY
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Zip | 11706-0279
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Country | US
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Telephone | 631-665-3666
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 143934
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License Number State | NY
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