1548247125 NPI number — DR. RICHARD H BLANCK M.D.

Table of content: DR. RICHARD H BLANCK M.D. (NPI 1548247125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548247125 NPI number — DR. RICHARD H BLANCK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANCK
Provider First Name:
RICHARD
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548247125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1991 MARCUS AVENUE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
LAKE SUCCESS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-466-4700
Provider Business Mailing Address Fax Number:
516-466-4810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1991 MARCUS AVENUE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LAKE SUCCESS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-466-4700
Provider Business Practice Location Address Fax Number:
516-466-4810
Provider Enumeration Date:
12/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  120724 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 120724-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0266413002 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 887956 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AS1292 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112434927 . This is a "ANTHEM HEALTH NETWORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112434927 . This is a "BEECH STREET CORPORATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112434927 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112434927 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112434927 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 173484 . This is a "EMPIRE PLAN/UNITED HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0350431 . This is a "EMPIRE HEALTHCHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112434927 . This is a "HORIZON HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112434927 . This is a "SELECT PRO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112434927 . This is a "TPA/BENESIGHT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OC2810 . This is a "PHS/ACS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 112434927 . This is a "ONE HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4394255 . This is a "AETNA MC/PPO/EPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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