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General NPI Number Information
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NPI Number | 1649377524
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Entity Type | Individual
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Provider Name | NESTOR D BLYZNAK MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 100 NICOLLS RD
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City | STONY BROOK
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State | NY
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Zip | 11794-8181
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Country | US
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Telephone | 631-444-6996
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Fax | 631-444-7671
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Provider Business Mailing Address
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Address Line | 100 NICOLLS RD
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City | STONY BROOK
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State | NY
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Zip | 11794-8181
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Country | US
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Telephone | 631-444-6996
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Fax | 631-444-7671
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 150695
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License Number State | NY
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