Provider Demographics
NPI:1093104473
Name:KEITH M. BLECHMAN, M.D., P.C.
Entity Type:Organization
Organization Name:KEITH M. BLECHMAN, M.D., P.C.
Other - Org Name:BREAST SURGERY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLECHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-573-8091
Mailing Address - Street 1:800A 5TH AVENUE
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7215
Mailing Address - Country:US
Mailing Address - Phone:212-427-3982
Mailing Address - Fax:604-282-3037
Practice Address - Street 1:800A 5TH AVENUE
Practice Address - Street 2:SUITE 300A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7215
Practice Address - Country:US
Practice Address - Phone:212-427-3982
Practice Address - Fax:604-282-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60251389208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty