MEDICARE: DR. ANDREW BLANK M.D.

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	207RG0100X	Gastroenterology Physician	208215	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

General Provider Information

NPI Number	:	1346233475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW BLANK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 95000-2409
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-0001
Country	:	US
Telephone Number	:	212-315-0144
Fax Number	:	212-315-0196

Provider Business Practice Location Address
First Line	:	1090 AMSTERDAM AVE
Second Line	:	10TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10025-1737
Country	:	US
Telephone Number	:	212-961-5530
Fax Number	:

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	04/16/2019

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Directions to “ DR. ANDREW BLANK M.D.” Practice Location

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