MEDICARE: DR. NANCY T. BLOCK 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	2084P0015X	Psychosomatic Medicine Physician	25MA0169800	NJ
2	2084P0800X	Psychiatry Physician	25MA01696800	NJ

General Provider Information

NPI Number	:	1457573644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY T. BLOCK M.D.

Provider Business Mailing Address
First Line	:	87 CROMWELL CT
Second Line	:
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1828
Country	:	US
Telephone Number	:	908-464-2174
Fax Number	:	908-464-4353

Provider Business Practice Location Address
First Line	:	87 CROMWELL CT
Second Line	:
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1828
Country	:	US
Telephone Number	:	908-464-2174
Fax Number	:	908-464-4353

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	10/12/2010

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