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General NPI Number Information
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NPI Number | 1790717114
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Entity Type | Individual
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Provider Name | JAY LAURENCE BLOCH MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 2301 EVESHAM ROAD SUITE #508
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City | VOORHEES
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State | NJ
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Zip | 08043-4506
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Country | US
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Telephone | 856-651-0500
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Fax | 856-651-0700
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Provider Business Mailing Address
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Address Line | 409 ROUTE 70 E SUITE #508
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2413
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Country | US
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Telephone | 856-651-0500
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Fax | 856-651-0700
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MA49807
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License Number State | NJ
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