Provider Demographics
NPI:1073635421
Name:BELTZER, BLAIR RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:RICHARD
Last Name:BELTZER
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 1:525 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2442
Mailing Address - Country:US
Mailing Address - Phone:973-953-7668
Mailing Address - Fax:973-904-0660
Practice Address - Street 1:510 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2025
Practice Address - Country:US
Practice Address - Phone:973-953-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA50889207Q00000X
NJ25MA05088900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1073635421Medicare PIN