Provider Demographics
NPI:1053328914
Name:BLUM, BRIAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PAUL
Last Name:BLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 E 28TH ST
Mailing Address - Street 2:APARTMENT 17A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8508
Mailing Address - Country:US
Mailing Address - Phone:210-834-7678
Mailing Address - Fax:
Practice Address - Street 1:247 E 28TH ST
Practice Address - Street 2:APARTMENT 17A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8508
Practice Address - Country:US
Practice Address - Phone:210-834-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002176622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00217662Medicaid