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General NPI Number Information
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NPI Number | 1710026018
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Entity Type | Individual
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Provider Name | PHYLLIS SUSAN BLACHARSH M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 680 HOWARD AVE
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-3525
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Country | US
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Telephone | 516-485-4527
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Fax | 516-485-4527
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Provider Business Mailing Address
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Address Line | 680 HOWARD AVE
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-3525
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Country | US
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Telephone | 516-485-4527
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Fax | 516-485-4527
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 80282
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 180127
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G76403
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License Number State | CA
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