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General NPI Number Information
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NPI Number | 1588082945
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Entity Type | Individual
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Provider Name | MICHAEL ANDREW BLASCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 378 SEAVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-2200
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Country | US
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Telephone | 718-226-6110
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Fax |
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Provider Business Mailing Address
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Address Line | 1 S CLINTON AVE APT 2103
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City | ROCHESTER
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State | NY
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Zip | 14604-1744
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Country | US
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Telephone | 847-609-9580
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 313587-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 036.158067
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License Number State | IL
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