Provider Demographics
NPI:1023391612
Name:BLACKSTONE, ANDREW SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SCOTT
Last Name:BLACKSTONE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1 SOMERDALE SQ
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-1345
Mailing Address - Country:US
Mailing Address - Phone:856-309-7700
Mailing Address - Fax:856-566-8944
Practice Address - Street 1:1 SOMERDALE SQ
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:NJ
Practice Address - Zip Code:08083-1345
Practice Address - Country:US
Practice Address - Phone:856-309-7700
Practice Address - Fax:856-566-8944
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB03194000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology