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NPI Code Detail

MEDICARE: DR. BRUCE B BLAU DDS

MEDICARE:  DR. BRUCE B BLAU  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist039110NY

General Provider Information

NPI Number : 1003818667
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE B BLAU DDS
Provider Business Mailing Address
First Line : 121 E 60TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10022-1117
Country : US
Telephone Number : 212-888-6311
Fax Number : 212-319-8388
Provider Business Practice Location Address
First Line : 121 E 60TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10022-1117
Country : US
Telephone Number : 212-888-6311
Fax Number : 212-319-8388
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 07/08/2007

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Directions to “ DR. BRUCE B BLAU DDS” Practice Location

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