MEDICARE: DR. BERNARD JACOB GOLDBLATT MD

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
1	207RC0000X	Cardiovascular Disease Physician	138482	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	138482	OTHER		LICENSE

General Provider Information

NPI Number	:	1306912019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD JACOB GOLDBLATT MD

Provider Business Mailing Address
First Line	:	1870 EAST 19 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11598
Country	:	US
Telephone Number	:	718-232-7877
Fax Number	:	718-232-4031

Provider Business Practice Location Address
First Line	:	1870 EAST 19 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11598
Country	:	US
Telephone Number	:	718-232-7877
Fax Number	:	718-232-4031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/12/2010

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