=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417030479
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEYER BLUMSTEIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 158 HEMPSTEAD AVE
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-593-3541
-----------------------------------------------------
Fax | 516-599-8307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 158 HEMPSTEAD AVE
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-593-3541
-----------------------------------------------------
Fax | 516-599-8307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 173357
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------